Verification of Membership Form

DELTA SIGMA THETA SORORITY, INC.

A SERVICE SORORITY

1707 NEW HAMPSHIRE AVENUE, N.W. WASHINGTON D.C. 20009

TO: EXECUTIVE DIRECTOR

SUBJECT: VERIFICATION OF MEMBERSHIP
DATE:*

MonthDay Year
Date
KINDLY COMPLETE THIS FORM IMMEDIATELY AND SUBMIT IT TO YOUR LOCAL CHAPTER TREASURER. THIS WILL INSURE AN ACCURATE RECORD OF YOUR MEMBERSHIP. YOUR COOPERATION IN THIS MATTER WILL BE GREATLY APPRECIATED.
1.NAME*
MEMBER NUMBER*
Email
example@example.com
2. ADDRESS

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
TELEPHONE (home/cell)*
TELEPHONE (work)*
3. NAME WHEN INITIATED*
4. APPROXIMATE DATE OF INITIATION*

MonthDay Year
Date
5. CHAPTER IN WHICH INITIATED*
6.LAST CHAPTER IN WHICH YOU PAID GRAND CHAPTER DUES*
NAME AT THAT TIME*
7.CHAPTER IN WHICH YOU WISH CURRENT MEMBERSHIP*
**FOR CHAPTER COMPLETION ONLY**
DATE E-MAILED TO GRAND CHAPTER

memberverification@deltasigmatheta.org
VERIFIED BY:

Clear
DATE

MonthDay Year
Date
Should be Empty: