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Associate Member Report Form



NOTE: This form is for your convenience. A hard-copy of the Associate member report and affidavit MUST be mailed to headquarters. Click HERE to get the PDF version of the form and affidavit, along with mailing instructions.

Chapter/Colony name:
Proposed Initiation Date:
(Must be within 63 days of the Associate Member Ceremony)


Full Name Date of AM Ceremony Class Year Home Address
(mm/dd/yy)(graduation date) (include zip code)


SUMITTED BY:
E-Mail Address:

Crest of Theta Xi Fraternity