Membership Information Request

 

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Membership Information Request

Your Full Name : 
Your Chapter : 
Your School : 
Preferred Mailing Address : 
City, State, ZIP : 
Preferred e-mail : 
Your preferred phone number : 
Date needed by : 
Intended purposes and use of information : 
What information would you like included in your report?
 Member roster number
 Member name
 Chapter
 School
 Member mailing address
 Member e-mail address
 Initiation year
 Graduation year
 Include members with no address (lost)
 Include undergraduates only
 Include alumni with good addresses only
 Undergraduates and alumni
 Include deceased members
Other (please specify) : 

Guidelines:
By my electronic signature, I indicate that I understand the following guidelines, and that I agree to appropriately safeguard the information released for my project: 

I understand and agree that use of this information for any purpose other than official Theta Chi Fraternity-related business as stated above is strictly prohibited, including any private, commercial or political mailings

If asked to return roster information by a representative of Theta Chi Fraternity, I am morally obligated to return all original information provided to me, and to destroy any duplicate paper copies or electronic records that I may have made or developed for the purposes of this one-time project

I will pass on any new or updated roster information to the International Headquarters so that Theta Chi Fraternity's records will be as accurate as possible.

 I agree to the terms and conditions stated above

 
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