Membership Record Request

Membership Record Request
Full Name*

First NameLast Name
E-mail*
example@example.com
I am a...
Chapter/Colony*
Alumni Club*
Province*

Membership Record Request
I am seeking members...

From a specific Chapter/Colony or UniversityWithin a specific city
Chapter/University
City
State
Reason for request (Please provide details)*
Please include...*

Full NameAssociated ChapterGraduation YearPrimary Phone NumberPrimary Email AddressPrimary Mailing AddressIf mail returns

Non-Disclosure Agreement
In connection with this Request, Sigma Pi Fraternity ("Sigma Pi") has allowed you access, or may allow you access, to personal information ("Proprietary Information," which term shall include, without limitation, anything you read as a result of exposure to or analysis of any Proprietary Information).

In consideration of your request, any disclosure concerning your interactions with Sigma Pi, you agree as follows:
1. You will hold in confidence and not disclose any Proprietary Information except in connection with the stated purpose of the request.
2. You will not use any Proprietary Information for personal or professional gain.
3. You agree to return any updates you receive to the data requested by sending them to records@sigmapi.org.
Signature*

Clear
Acknowledged and agreed on

MonthDayYear
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