New Member Report Form

Chapter Official: List the names of new Sigma Zeta members on this form. The names are to be in alphabetical order by last name. Send the list to the National Executive Director with the $25.00 national membership fee for each student member listed. Upon receipt of this form and the proper membership amount, membership certificates will be mailed to your chapter.

Please type or print the names and spell all names correctly and carefully. Keep a copy of the completed list of names for your chapter's files.

Chapter

First Name

Middle Name or Intial

Last Name

Title (Jr., III, Ph.D)

Status (S=Student, F=Faculty)

Year (4 Digits )

Day (Full Spelling)

Month (Full Spelling)

This is to certify that the members listed above were initiated as ACTIVE MEMBERS in the ___________________________________ Chapter of SIGMA ZETA on ___________________________________(mm/dd/yy)

Certified by ___________________________________ Office of signee ___________________________________

Signature

Chapter Advisor ___________________________________