| Name: |
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| Email Address: |
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| Mailing Address: |
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| City, State, Zip Code: |
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| Phone Number: |
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| Alternative Phone Number: |
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| Birthdate: |
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| Age: |
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| Your Personal Homepage: |
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| Where did you locate our organization: |
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| Have you ever participated in a Membership Intake Process for ANY Greek Lettered organization: |
YES
NO
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| If yes, which organization: |
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| Are you or have you been a member of ANY Greek-Lettered organization: |
YES
NO
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| If yes, which organization: |
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| Are you (for statistical purposes only): |
Caucasian
African American
Hispanic
Asian
Other
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| What is your sexual orientation: |
Lesbian
Bisexual
Heterosexual
Gay Friendly
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| Which best describes you: |
Feminine
Aggressive Femme
Butch
Soft Stud
Stud
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| Number of Years: |
0-1
1-2
2-3
3-4
4-5
5+
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| Are you currently working: |
YES
NO
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| Are you currently attending school: |
YES
NO
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| Are you looking to charter a chapter in your city: |
YES
NO
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| Community Involvement(s): |
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| Special Interest(s): |
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| Comment(s): |
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