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Upsilon Tau Chapter

Mid-Hudson Valley, New York

RECLAIMATION FORM

Enter your information below. You will be contacted shortly by our  
Reclamation Committee regarding the reclamation process.

(* denotes required)

Member ID: (i.e. your 9-digit Control Number)

Chapter of Initiation

*

Initiation Date

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Last Chapter of Affiliation

Please provide current address information below:

Name (First, Middle, Last)

*

Home Address, City, State, Zip Code

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Preferred Contact Number

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E-mail

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Thanks for submitting brother!