Tsoiotsi Tsogalii

Dues Form

Dues are Currently $10.00

Dues Paid Through

Membership (O,B, or V)

First Name, MI, Last Name

Address:

City, State, Zip

Home Phone

Date of Birth

Ordeal Date

Brotherhood Date

Vigil Date

Unit Number

Chapter

Email Address

Mail completed form to:

Old North State Council, PO Box 29046, Greensboro NC 27429-9046