VERIFICATION OF MEMBERSHIP
PLEASE COMPLETE THIS FORM IMMEDIATELY. FOR ADMITTANCE TO A MEETING, SUBMIT IT NO LATER THAN 72 HOURS PRIOR TO LOCAL CHAPTER MEETING. THIS WILL ENSURE AN ACCURATE RECORD OF YOUR MEMBERSHIP. YOUR COOPERATION IN THIS MATTER WILL BE GREATLY APPRECIATED.
MEMBERSHIP #
*
NAME
*
Prefix
First Name
Middle Name
Last Name
Email
*
example@example.com
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CONTACT #
*
-
Area Code
Phone Number
NAME WHEN INITIATED
*
APPROXIMATE DATE OF INITIATION
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
CHAPTER IN WHICH INITIATED
*
LAST CHAPTER IN WHICH YOU PAID GRAND CHAPTER DUES
*
NAME AT THE TIME
*
CHAPTER IN WHICH YOU WISH CURRENT MEMBERSHIP
Upload your a copy of your membership card
*
Browse Files
Acceptable formats are pdf, jpg, jpeg, png, gif (File size limit 3MB)
Cancel
of
Upload your a copy of photo identification
*
Browse Files
Acceptable formats are pdf, jpg, jpeg, png, gif (File size limit 3MB)
Cancel
of
Are you interested in attending the next Chapter meeting?
*
Yes
No
Are you interested in seeking membership with Jefferson County Alumnae Chapter?
*
Yes
No
Submit
Should be Empty: