New Inquiry Form

1

Name:* This field is required.

First Name

Last Name

2

Birthdate:* This field is required.Note: Must be at least 25 years old at time of submission. If under 25, please call 404-348-2354.

Date

3

Address:* This field is required.NOTE: You must reside in Fulton, Dekalb, Gwinnett, Cobb, Clayton, Coweta, Douglas, Fayette, or Henry counties.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

4

Email:* This field is required.example@email.com

5

Phone Number:* This field is required.

Area Code

Phone Number

8

Comment/Question

9

* This field is required.I understand that by checking the following box, Kappa Psi Theta Fraternity, Inc. in no way guarantees membership based on inquiry form submission. Kappa Psi Theta Fraternity, Inc. is a lesbian fraternity and uses its own discretion in selecting members.

10

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