<p> PHI ALPHA THETA MEMBERSHIP APPLICATION </p><p>First Name: ______Middle Initial:____ Last Name: ______</p><p>Permanent address [for mailing The Historian]:</p><p>Street: ______</p><p>City, State, Zip: ______</p><p>Telephone: (____) ______</p><p>Local/Campus address:</p><p>Street: ______</p><p>City, State, Zip: ______</p><p>Telephone: (____) ______E-mail address: ______</p><p>Dates at LSU: ______</p><p>Major(s) at LSU: ______Minor(s):______</p><p>Expected degree(s): ______Expected date of graduation: ______</p><p>Other Colleges/Universities attended: ______</p><p>______</p><p>Dates: ______</p><p>Major: ______Minor: ______Degree: ______</p><p>Date of graduation: ______</p><p>Clubs/activities: ______</p><p>______</p><p>______</p><p>Historical interests: ______</p><p>______</p><p>Please enclose a check for $50 made out to Phi Alpha Theta, Zeta Eta Chapter. Turn in completed application and check to Prof. Carolyn Lewis, Dept. of History, 231B Himes Hall, LSU, Baton Rouge, LA 70803. ______</p><p>Do you have an interest in . . .? [check any that apply]</p><p>A graduate degree in History ____ Law school ____ Teaching in High School ____</p><p>Other graduate program ____ Describe: ______</p><p>Please enclose a check for $50 made out to Phi Alpha Theta, Zeta Eta Chapter. Turn in completed application and check to Prof. Carolyn Lewis, Dept. of History, 231B Himes Hall, LSU, Baton Rouge, LA 70803.</p>