Kappa Kappa Gamma

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Name:

Street Address:

City:

State:

Zip Code:

Home Phone*:

Business Phone*:

Mobile Phone*:

Email Address:

Chapter:

Initiation Year:

School Name:

Birthday:

Occupation:

Company Name:

College degrees earned/other certifications:

List at least three interests or hobbies:

Spouse's Name:

Children's names and ages (if living at home):

Philanthropic Activities:

One thing you'd like other Kappas to know about you:

One thing you'd like to accomplish in the next year:

Communications Preferences:

Lunch Bunch (monthly social luncheons)
Kappa Dinners (occasional social dinners)
Regular Meetings (monthly program meetings)

How should we contact you? (Please provide phone number below if Option 2 is chosen):

Email (We will not call you regarding meetins except in case of emergency (last-minute cancellations, etc.)
Phone Please provide the number at which we are most likely to reach you.)

Emergency Phone Number:

Verification:

7 add 5

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