Order Directory

Directory Payment Form

Name *

Phone

Directory Order

Color Pages $25 + 1.41 =$26.41 (directory)

B&W Pages $17 + 1.12 = $18.12 (directory)

Binder $10 + 0.87 = $10.87 (directory)

Preloaded Flash Drive $6 + 0.72 = $6.72 (directory)

Mail binder pages $15 + 1.05 = $16.05 (directory)

Mail flash drive $5+ 0.69 = $5.69 (directory)

Directory Updates

Please only fill out the section below if you are new to the chapter or have an update to your current information.

Please only fill out this section if you have new updates to make.

Address

Apt, suite, etc.

Country

City

State

Zip code

Home Phone

Cell Phone

Chapter of Initiation

Year of initiation

Birthday (Month and Day only)

Spouse's Name

Profession