New Associate Application
Please complete this application and where applicable, submit it along with proof of your status as a graduate
mother in good standing (i.e., letter from current/former Chapter President or Completion of Tenure Certificate).
Member Information
Date New Associate’s Name
Address
City State Zip
Email Address Home Phone Cell Phone
Child/Children Information
M F Y N
Name Age Gender Legacy Granted?
M F Y N
Name Age Gender Legacy Granted?
M F Y N
Name Age Gender Legacy Granted?
Chapter Affiliation
ssociate Group? Yes No
Name of Chapter
Number of Years in this Chapter Number of Years in Other Chapters
Have you served on the Regional/National Level? Yes No
Position/Committee(s) and years:
Have you served on the Chapter Executive Board? Yes No
Have you served as a Chapter Committee Chai
? Yes No
Have you attended any National Conventions? Yes No
Have you attended any Regional Conferences? Yes No
Have you attended any Mothers Workday Clusters? Yes No
s an Active Associate, how are you willing to support our chapter? (check all that apply)
olunteer service/assistance at specified events
Guest speaker/share expertise
Chapter Fundraise
Mothers Away from Home Program
Othe
:
The information herein contained is true and correct to the best of my ability.
Signature
click to sign
signature
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