Tsoiotsi Tsogalii
Extended Membership Form
q
$100
– 12 Years
q
$200
– 25 Years
|
Dues Paid
Through |
|
|
Membership
(O,B, or V) |
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|
First
Name, MI, Last Name |
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|
Address: |
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City,
State, Zip |
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Home
Phone |
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Date of
Birth |
|
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Ordeal
Date |
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Brotherhood
Date |
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Vigil
Date |
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Unit
Number |
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Chapter |
|
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Email
Address |
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***These can only be accepted at Fall Fellowship, Spring
Fellowship, or in the