Epsilon Gamma Iota
This form is to update the National Advisory Board contact list and confirm membership information.
General Information
First Name *
Last Name *
Email Address *
Preferred Methods of Contact *
Required
Membership Information
Crossing Chapter *
Crossing Semester
Clear selection
Crossing Year
Crossing Date
MM
/
DD
/
YYYY
Line's Name
Example: 38 Minds of Success
Your Line Number
Your Line Name
Please Use Maiden Name - Ex: Jocelyn "Smiley" Atkins
Your MC
Your AMC
Have You Ever Received A Membership Card? *
Would You Like To Purchase A Replacement Card for $5?
Clear selection
Personal Information
The following information will only be used for official Epsilon Gamma Iota business and membership statistics for sponsors. Your information will not be distributed to the membership at large.
Street Address
City *
State *
ZIP Code
Phone Number
Undergraduate Major
Undergraduate Graduation Year
Advanced Degrees & Year Obtained
Separate Each Set With A Comma - Ex: Master of Science 2007, Doctor of Engineering 2015
Occupation
Place of Employment
Title/Position
Social Media Accounts
Facebook
Instagram
Twitter
LinkedIn
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