NCTA Verification Form

DELTA SIGMA THETA SORORITY, INC.

A SERVICE SORORITY

1707 NEW HAMPSHIRE AVENUE, N.W.

WASHINGTON, D.C. 20009

TO: EXECUTIVE DIRECTOR

SUBJECT: VERIFICATION OF MEMBERSHIP

KINDLY COMPLETE THIS FORM IMMEDIATELY AND SUBMIT IT TO YOUR LOCAL CHAPTER TREASURER. THIS WILL ENSURE AN ACCURATE RECORD OF YOUR MEMBERSHIP. YOUR COOPERATION IN THIS MATTER WILL BE GREATLY APPRECIATED.
Full Name *

First Name Last Name
Membership Number *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Name When Initiated *

First Name Last Name
Approximate Date of Initiation *

Month Day Year
Date
Chapter in Which Initiated *
Last Chapter In Which You Paid Grand Chapter Dues *
Name At That Time

First Name Last Name
Chapter In Which You Wish Current Membership *
Are You A First Time Visitor to NCTA? *

Yes No
E-mail *
example@example.com
Mobile Phone Number
How Did You Hear About NCTA? *

Website/Social Media Referring Soror Event Other
Referring Member of NCTA (if applicable)
If you have a copy of your membership verification form from the sisters' only portal please upload

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