Chi Rho Infomation and Status Change Form
Please Fill out this form as completly as possible.

Name
First Middle LastMaiden
Address
(parents address
if student)
GenderMF
CityStateZipCountryHome Phone
Preferred E-mailAlternate E-mail
MajorGraduation DateHometown(while in school) Company (if graduated)Birthday
Status Active Pledge InActive Alumnus Honory Member Other
Pledge Class Date Initiated Chapter Texas Tech Lamar
Univ. of New Mexico
Big Bro (and pledge class)
Lil Bro (s) (and pledge class)
Chi Rho Offices / Committiees held / Awards / Misc. Info (include years)