ZETA CHI ALUMNI CHAPTER Annual Membership Form JOIN NOW! Membership in the Zeta Chi Alumni Chapter helps to underwrite the ongoing costs of publishing the Zeta Chi Alumni Newsletter and other initiatives to help Zeta Chi alumni stay connected to each other and their fraternity. Instructions: Complete the form below and return along with your $25 check or money order to: Jim DeLuccia 407 Gregorys Way Voorhees, NJ 08043 In an effort to keep production costs low, we are encouraging all Zeta Chi alumni who have an active e-mail address to consider receiving the Zeta Chi Alumni Newsletter in an electronic format. Future editions of the newsletter will be sent in PDF format. Please check the box below indicating your preference. Leave the square blank to receive a hard copy in the mail.
□ I would prefer to receive future editions of the Zeta Chi Data in an electronic format. In 2006, the Zeta Chi Alumni Chapter will be launching a web site dedicated to promoting alumni events and facilitating more effective alumni communication. An “opt-in” is required to post your listing.
□ I would like to have my name, initiation year, and e-mail address listed on the Zeta Chi Alumni Chapter web site. PRIVACY AGREEMENT: By providing the above personal information, I understand and consent to such information being shared with the records departments of Pi Kappa Phi Fraternity and the Zeta Chi Alumni Chapter. Questions regarding the Zeta Chi Alumni Chapter should be directed to: Alumni Chapter President Mike Netznik msnsih@hotmail.com cell: 484-332-1617 Contributions or gifts to the Zeta Chi Alumni Chapter are not deductible as charitable contributions for federal income tax purposes This questionnaire will be used for updating and maintaining contact information for the Alumni Chapter, as well as for the Undergraduate Chapter.
NAME: ________________________________ DATE OF BIRTH: ______________________ ADDRESS: ___________________________________________________________________ PHONE NUMBERS: Home: _______________________________________________ Cell: _________________________________________________ Work: ________________________________________________ E-MAIL ADDRESS: _____________________________________________________________ AOL IM SCREEN NAME: _________________________________________________________ INITIATION NUMBER: ___________________________________________________________ INITIATION CLASS: _____________________________________________________________ NICKNAME: ___________________________________________________________________ MAJOR WHILE AT ALBRIGHT: ____________________________________________________ CURRENT JOB TITLE: ___________________________________________________________ CURRENT EMPLOYER: __________________________________________________________ SIGNIFICANT ACCOMPLISHMENTS: ________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ FAMILY UPDATES (Marriage, Children, Significant other, etc.): ____________________________ _________________________________________________________________________________ ________________________________________________________________________________ This form can also be emailed to Alumni Chapter Secretary Bryan Mulvihill: mulvazx101@yahoo.com