Grand chapter duplicate membership card request form



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Delta Sigma Theta Sorority, Inc.

A Service Sorority

GRAND CHAPTER


DUPLICATE MEMBERSHIP CARD REQUEST FORM

Member No: __________

Name: _____________________________________________________________
Please print name as you wish it to appear on your card. Only 26 characters and spaces are embossed on the card.

Current Chapter: _____________________________________________________

Mailing Address: _____________________________________________________

City/State: ____________________________________ Zip code: ___________

Telephone Home: ___________________ Work: __________________

Email Address _______________________________________________________


********************************
If your member number is unknown, please complete the following information:
Name When Initiated: __________________________________

Chapter of Initiation: ___________________________________

Date When Initiated: __________________

____________________________________


Signature
____________________________________
Date
NOTE: Please allow at least four to six weeks for processing. Mail, fax (202.797-7520) or email the form to memberrelations@deltasigmatheta.org


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