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
*
Last Chapter of Affiliation
Please provide current address information below:
Name (First, Middle, Last)
*
Home Address, City, State, Zip Code
*
Preferred Contact Number
*
E-mail
*
Thanks for submitting brother!