Phi Beta Sigma Fraternity Inc.
Omicron Sigma Chapter

P.O. Box 295381, Lewisville, TX 75209
E-mail: Membership@Sigmamail.org

TRANSFER/REINSTATEMENT REQUEST

(PLEASE PRINT OR TYPE and answer all questions)

Date

 

 

 

Select Type

 

PERSONAL DATA

Name

 

 

 

 

Last

First

Middle

Permanent Address

 

 

Street

 

 

 

 

 

 

City

State

Zip Code

 

Daytime Telephone #:

 

Evening Telephone #:

 

 

E-Mail Address:

 

Website:

 

 

MEMBERSHIP INFORMATION

With what chapter were you last financial?

Chapter

 

Region

 

 

Year

 

Card Number

 

 

Chapter of Initiation

 

Region

 

Date of initiation, if known