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NEDAA Membership Form (2018)
Note: This form and dues are due by the start of the Northeast District Convention to be considered active at the convention.
Membership Status *
Required
Last Name *
Your answer
First Name *
Your answer
Maiden Name
Your answer
Email *
Your answer
Phone *
Easiest Number to Reach You At
Your answer
What kind of phone number is this? *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Birthday
MM
/
DD
/
YYYY
Which organization(s) do you belong to? *
Required
Chapter Designation *
Greek Name
Your answer
College/University *
College/University
Your answer
Initiation Date *
Month, Year
Your answer
Graduations Date *
Month, Year
Your answer
Major *
Your answer
Please list any Graduate Degree or post-graduate programs that you have completed
Your answer
Career
Your answer
Please check if you are currently a member of... *
(Select all that apply)
Required
Other Chapters/Districts
KKY/TBS, Greek Name, College/University/District, Honorary/Transfer, Date
Your answer
Other Alumni Associations
List all other current alumni association memberships
Your answer
Payment Information
Membership Type *
The other box is for additional donations
Required
Payment Type *
Please note, if you pay via PayPal there is a $2 service fee.
Check Number
If you pay via check, please put the check number here.
Your answer
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