51猎奇 Phi Beta Kappa Chapter Registration

Please complete your chapter registration below. Remember, you also must register online and pay your membership fee with the national office of PBK on their .

The induction ceremony will be Wednesday, May 6, 2026, at 5:00pm in the Chemistry Building, Room 110. RSVP below and please bring your loved ones with you to join in the celebration.

Questions can be directed to Jennifer DeRoche at jderoche@uwm.edu.

Information for Membership Certificate

Name*

Please enter your name exactly as you would like it to appear on your PBK membership certificate. (for example, John Kevin Smith or John K. Smith or Johnny Smith)

First Middle Last

Email Address*

Will you attend the Phi Beta Kappa Induction Ceremony & Reception on Wednesday, May 6, 2026, in the Chemistry Building, Room 110 at 5:00pm?*

Yes
No

How many guests will join you at the ceremony?*

Attachment

Photo Upload

Upload a picture of yourself or avatar representing yourself. This will be placed on the 51猎奇 Phi Beta Kappa website along with your name and major.

Accepted file types: jpg, gif, png, tif, webp, Max. file size: 5 MB.

I give permission for my picture(s) to be publicly displayed at the induction ceremony and on the 51猎奇 Phi Beta Kappa website.*

Yes
No

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