• Please use full names.
• For required fields that are not applicable for your chapter please enter N/A.
• For date fields that are in the future and you do not know an exact date please enter the approximate month and year and 1 for day of the month.

= Required Field

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Chapter Phone Number
Chapter Mailing Address
Chapter Shipping Address
Chapter City
Chapter State/Province
Chapter Zip
Chapter Website
Last Rush Date (MM/DD/YYYY)
Next Rush Date (MM/DD/YYYY)
Last Pledging Date (MM/DD/YYYY)
Next Pledging Date (MM/DD/YYYY)
Last Initiation Date (MM/DD/YYYY)
Next Initiation Date (MM/DD/YYYY)
Date of Last Election (MM/DD/YYYY)
Next Scheduled Election (MM/DD/YYYY)
Chapter President Name
Email
Phone
Date of Election (If different than Last Election date above)
School Mailing Address (If different than Chapter mailing address)
Treasurer Name
Email
Phone
Date of Election (If different than Last Election date above)
School Mailing Address (If different than Chapter mailing address)
Secretary Name
Email
Phone
Date of Election (If different than Last Election date above)
School Mailing Address (If different than Chapter mailing address)
VP Membership Education Name
Email
Phone
Date of Election (If different than Last Election date above)
School Mailing Address (If different than Chapter mailing address)
VP Membership Recruitment Name
Email
Phone
Date of Election (If different than Last Election date above)
School Mailing Address (If different than Chapter mailing address)
VP Loss Prevention Name
Email
Phone
Date of Election (If different than Last Election date above)
School Mailing Address (If different than Chapter mailing address)
VP Scholarship Name
Email
Phone
Date of Election (If different than Last Election date above)
School Mailing Address (If different than Chapter mailing address)
VP Public Relations Name
Email
Phone
Date of Election (If different than Last Election date above)
School Mailing Address (If different than Chapter mailing address)
Associate Member Educator Name
Email
Phone
Date of Election (If different than Last Election date above)
School Mailing Address (If different than Chapter mailing address)
Human Services Chairman Name
Email
Phone
Date of Election (If different than Last Election date above)
School Mailing Address (If different than Chapter mailing address)
Submitters Name (Person filling out this form)
Office
Email
Phone