NCTA Verification Form (2024-2025)

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

KINDLY COMPLETE THIS FORM IMMEDIATELY AND SUBMIT IT TO YOUR LOCAL CHAPTER TREASURER. THIS WILL ENSURE AN ACCURATE RECORD OF YOUR MEMBERSHIP. YOUR COOPERATION IN THIS MATTER WILL BE GREATLY APPRECIATED.
Full Name*

First NameLast Name
Membership Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Name When Initiated*

First NameLast Name
Approximate Date of Initiation*

MonthDayYear
Date
Chapter in Which Initiated*
Last Chapter In Which You Paid Grand Chapter Dues*
Name At That Time

First NameLast Name
Chapter In Which You Wish Current Membership*
Are You A First Time Visitor to NCTA?*

YesNo
E-mail*
example@example.com
Mobile Phone Number
How Did You Hear About NCTA?*

Website/Social MediaReferring SororEventOther
Referring Member of NCTA (if applicable)
If you have a copy of your membership verification form from the sisters' only portal please upload

Cancelof
Should be Empty: