DELTA SIGMA THETA SORORITY, INCORPORATED Membership Information Form

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					DELTA SIGMA THETA SORORITY, INCORPORATED Membership
Information Form
*FOR DELTA USE ONLY
PERSONAL INFORMATION
Name
Address
City:                        State:                    Zip:
Home #:                      ()           Cell #:   ( ) Email:
Date of Birth:                               Place of Birth:
EMERGENCY CONTACT
Please list the name(s) of person(s) to be contacted in case of an emergency:
Name/Relationship:                           Name/Relationship:
Address:                                     Address:
City/State/Zip:                              City/State/Zip:
Phone#:                      ()              Phone#: ( )
EDUCATION
College/University:                          Degree Earned:
College/University:                          Degree Earned:
Other:                                       Degree/Certificate Earned:
PROFESSIONAL INFORMATION
Employer:                                    Title:
Business Name:                               Business Type:
Career(s):
Community Involvement/Organizations:


Honors/Awards (Public and Professional):


Briefly summarize anything else that you would like others to know about
you.

DELTA INFORMATION
Name at time of Initiation:
Chapter and place of Initiation:
Year of Initiation:
Current Chapter Affiliation:
Chapter Offices Held:
Regional/National Offices Held:
OMEGA OMEGA SERVICE
Would you like the Omega Omega Service to be held at a different time or part of
your memorial service? (Please () check one of the below options)
Different Time                             Same Time
Special Soror Participants: (list names in Other Sorors: (list at the end of this
the section below Special Song)            form)
Special Song:
Please list the name(s) of one or more special soror(s) who is/are most familiar
with your Delta, professional or personal activities whom you wish to be
contacted:
Name:                                          Name:
Address:__________                             Address:
City/State/Zip:                                City/State/Zip:
Phone#:                           ()           Phone#:                       ()
Please list the name(s) of one or more special soror(s) who is/are most familiar
with your Delta, professional or personal activities whom you wish to be
contacted:
Name:                                          Name:
Address:                                       Address:
City/State/Zip:                                City/State/Zip:
Phone#:                           ()           Phone#:                       ()
Have you designated a Delta to receive your Delta collectibles, including
confidential materials such as rituals, constitution, protocol handbook, pins,
paraphernalia, etc?
Yes                                            Please list Soror's name and phone
                                               #:
No
If you have not designated a Delta to receive your Delta collectibles, would you
agree to have them transferred to the chapter archives?
Yes                                            Please list a family contact name
                                               and phone #:
No
Other Sorors to Participate in Omega Omega Service:


           Email completed form to cacomegaomega@yahoo.com

				
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