Permission Form 

I _____________________ give the Alpha Pi web master permission for  

(Please check all that are appropriate)

_____ my name   

_____ my address 

_____ my phone number 

_____ my e-mail address 

to be included on the Alpha Pi State Web Page.

 _________________________________      ______________________________
Name                                                               Date

Send to:
Crystal Pauli
crystal.pauli@dsu.edu

Please direct comments and inquires to Dr. Crystal Pauli

11/17/2009