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Membership Application

 

Note: If you want join a chapter pick the school your applying to. If you want to start a chapter click "I want to start a chapter!!!" under school. 

First:   Middle:    Last: 

Address: 

City: 

State:   Zip:

Phone: --

Email:

Social Security Number:

Retype SS#:

School: (Want information on how to start a chapter on your campus? Click Here)

Classifaction:

Major:

Date of Birth:

Church:

Church Address:

City:

State:     Zip:

Pastor name:

    By placing your FULL name in the box below you authorize the above is true and is given to induce Alpha and Omega to extend membership to you. also authorize Alpha and Omega to make any investigation it sees fit. You also authorize Student development to disclose to Alpha and Omega any and all information concerning the personal and academic history of you.

Signature:   Date: