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Theta Alpha Kappa Change of Chapter Representative Form
Please complete this form whenever your chapter has a faculty leadership transition.
First name of the OUTGOING chapter representative *
Your answer
Last name of the OUTGOING chapter representative *
Your answer
Email address of the OUTGOING chapter representative *
Your answer
First Name (and middle initial, if desired) of the NEW chapter representative *
Your answer
Last Name of the NEW chapter representative *
Your answer
Postal address of the NEW chapter representative *
Your answer
City *
Your answer
State (two-letter postal abbreviation) *
Your answer
ZIP code *
Your answer
Phone number of the NEW chapter representative *
Your answer
Email address of the NEW chapter representative *
Your answer
The semester (Fall or Spring) and year when the change of leadership will become (or became) effective *
Your answer
Academic Institution *
Your answer
TAK Chapter Number *
Your answer
TAK Chapter Greek Letters (spelled out, e.g., Alpha Beta Gamma) *
Your answer
Thanks for completing this form. If you do not receive an email confirmation message shortly at the address you provided above, please contact us at ericfmason@gmail.com.
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