Interest Form

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Area Code

Phone Number

3

Email* This field is required.

example@example.com

4

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

5

I am interested in:* This field is required.

Lambda Alpha Kappa Nu Sorority (Sorority for all women)

Lambda Zeta Phi Nu Fraternity (Masculine of center lesbains)

Lambda Gamma Omega Nu Fraternity (Trans Men)

Lambda Beta Delta Nu Fraternity (Cis-gender Men)

6

Are you 21 or older? * This field is required.

YESNO

7

Are you member or have you ever been a member of Greek lettered organizations, or service or social organizations/clubs?* This field is required.

YESNO

8

If you answered yes what organization?Put N/A if this does not apply to you.

9

Are you active in your community? * This field is required.

YESNO

10

Are you a registered voter?* This field is required.

YESNO

11

I have access to the following:

Cell Phone

Tablet (IPad/Android Tablet)

Computer/Laptop

Internet

12

If you have a Facebook page please provide username.* This field is required.Put N/A if this does not apply to you.

13

How did you hear about us?

14

Signature* This field is required.

15

Date

Date

16

* This field is required.Terms & Conditions

17