MEMBERSHIP CERTIFICATION FORM

MEMBERSHIP CERTIFICATION FORM

CHI ETA PHI SORORITY, INCORPORATED®
Directions: This form is to be completed when membership needs to be verfied and confirmed.

The member requesting to reactivate should complete this form and forward it to the Reclaiming Officer's email.
If you are experiencing issues with this form, please email IT@chietaphi.org.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Email*
example@example.com
CHAPTER you desire to REACTIVATE into: (please spell out the chapter name/ No Greek Letters or Abbreviations)*
Original Intake Chapter Name:*
Original Intake Year:*
Membership Certified by: Check all that apply*

Membership CertificateMembership CardTransfer Release form from Chapter Basileus or Regional DirectorYearbook (Beta only)Glowing Lamp or JOCEPSLetter on organization's letterhead/stationary verifying membership; to include two (2) signatures from active members of the executive board from the last active chapter.Pictures with other Sorors and Fraters representing us in the community.Other
Membership Certified by the attached document(s)/photo(s) to provide proof of certification of membership. *

Cancelof
Sender's Email:*
example@example.com
Date *

MonthDayYear
I attest on this date my submission is true.
I attest that all of the above information provide related to my membership certification is true and correct.*

Created 9/2024 by Stacey Johnson National Secretary 2021-2025
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