Pre-Verification Form

Pre-Verification Form

For Augusta Alumnae Chapter -Delta Sigma Theta Sorority, Inc.
Full Name *

First Name Last Name
Are you a first-time visitor? *

Yes No
Membership Number *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
E-mail *
Date of Initiation

Month Day Year
Date
Initiating Chapter *
If initiated as a collegiate please include the name of college/university
How did you hear about us?

Website/Social Media Referring Soror Event
Referring Member of Augusta Alumnae Chapter
Should be Empty: