Membership Verification Form

Membership Verification Form

Please complete this form to verify your membership details for Delta Sigma Theta Sorority, Incorporated Indianapolis Alumnae Chapter. Submit the completed form for accurate record keeping.
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City, State
Zip Code
Email Address
example@example.com
Member Number
Approximate Date of Initiation

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Chapter Where Initiated
Full Name at the time of initiation

First NameLast Name
Are you currently a financial member?
Chapter through which you paid Grand Chapter dues
Date Submitted To Grand Chapter

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Chapter where you would like to be an active/current member
Verified
Should be Empty: