Phi Psi Ladies

Please print Datasheet and fax or mail.
You may also type in the information and send by E-mail.

Please fill out and return to: Janie Keller FAX: (225) 928-5899
P O BOX 14358 Phone: (225) 767-6629
Baton Rouge, LA 70898 E-Mail: Dkeller655@aol.com

Date: ___________________

Name ____________________________________________________________________

Address __________________________________________________________________

City ____________________________________ State _______ ZIP ________________

Husband ________________________________________________________

Chapter _______________________________ Year Initiated ____________

Home Phone   (___________)_______________________________________

Work Phone  (___________)_______________________________________

FAX Phone  (___________)________________________________________

E-Mail _________________________________________________________

Home Page http://____________________________________________________________

Birthday ________________________________

Comments: __________________________________________________________________

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