Chi Rho Infomation and Status Change Form

Please Fill out this form as completly as possible.
Name
	First	Middle	Last		Maiden
Address (parents address if student)					GenderMF
	City	State	Zip	Country	Home Phone
	Preferred E-mail		Alternate E-mail
	Major	Graduation Date	Hometown(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)