Phi Alpha Theta Application

Name
First Last
Name, as you want it to appear on the certificate (e.g., First MI Last):
UWM Email Address
Address (for mailing the journal). The organization wants something called a "permanent address" so they can send you information after you have graduated from UWM. Please just put here whatever address you would like.
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country