ZETA PHI BETA SORORITY, INCORPORATED
XI MU ZETA CHAPTER
P.O. Box 497
Markham, Illinois 60428-0497
1.877.XMZ.1989
1. Name __________________________________________________________________
Last
First
MI
__________________________________
Maiden Name (if
applicable)
2. Address___________________________________________________________
_________________________________________________________________
Telephone _______________________ E-mail ___________________________
3. Birthdate _________________________________________________________
4. Employer_________________________________________________________
5. Job Title__________________________________________________________
6. Emergency Contact
_________________________________________________________________
Name
Relationship
_________________________________________________________________
Address
Telephone Number
7. Other Activities/Community Involvement: (please include an address and contact person) __________________________________________________________________
__________________________________________________________________
__________________________________________________________________
8.
Other skills and abilities:_____________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
9. Comments (include anything you want us to know about you):_______________
__________________________________________________________________
Circle one: Reactivation New Membership Amicae Archonette Amicette