Verification of Membership
Kindly complete this form and submit. This will ensure an accurate record of membership. Your cooperation in this matter will be greatly appreciated.
Online verification can be completed up to 48 hours before the next meeting, otherwise you will be asked to fill out a verification form in person at the meeting. Please bring Photo I.D.
Membership Number:
*
Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name when initiated (if different)
First Name
Last Name
Approximate date of initiated
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Chapter of Initiation
*
Last chapter in which you paid grand chapter dues:
Chapter of current membership:
Name of the person who invited you to the meeting:
Submit
Should be Empty: