This form will register you for Delta Chi Fraternity Rush for Fall 1999. Filling out this brief information form will give us some vital information about you and will allow us to contact you for all of our recruitment events in the next couple of weeks.

First Name:

Last Name:

Birthdate
(use mm/dd/yyyy format):

Permanent Address:
(Street, City, State, Zip)

Permanent Phone Number:

School Address:
(If Known)

Dorm and Number:
(If Known)

A&M Phone Number:

E-mail Address:

High School Attended:

Are you a Delta Chi legacy? If so, list the relationship (i.e. father, uncle, grandfather, etc.), name, and school of your relative.

© Delta Chi Fraternity - Texas A&M Chapter 1988-1999
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