RAC DST | Membership Verification Form

Membership Verification Form

Please complete the following form at least 48 hours before the Chapter Meeting so we may verify your membership prior to our Chapter Meeting.
Name

First NameLast Name
Are you a first time visitor?
Membership Number
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:

Area CodePhone Number
E-mail
Date of Initiation

MonthDayYear
Initiating Chapter
If initiated as a collegiate please include the name of college/university
Where did you hear about us?

Other
Referring Member of Rome Alumnae Chapter
Once you submit your verification form, we will contact you within 48 hours to regarding your attendance to our Chapter Meeting.

Thank you!
Please verify that you are human
Should be Empty: