Your Name (required)

Your Email (required)

Address (required)

Street, City, State, Zip

Phone (required)

Birthdate

Age

Personal Homepage:

Where did you learn about our organization?

Have you ever participated in a Membership Intake Process for ANY Greek Lettered organization:

 Yes No

If yes, which organization:

Are you or have you been a member of ANY Greek-Lettered Organization:

 Yes No

If yes, which organization:

Are you (for statistical purpose only):

 Caucasian African American Hispanic Asian Other

What is your sexual orientation: (required)

 Lesbian Bisexual Heterosexual Gay Friendly

Which best describes you: (required)

 Feminine Aggressive Femme Butch Soft Sud Stud

Number of Years:

 0-1 1-2 2-3 3-4 4-5 5+

Are you currently working:

 Yes No

Are you currently attending school:

 Yes No

Are you looking to charter a chapter in your city:

 Yes No

Community Involvement(s):

Special Interest(s):

Comment(s):