This form is DUE within two weeks of declaring an inactive status and MUST be submitted by EVERY member who goes inactive.
Region: Eastern Southern Central Western Chapter Name:
Member's Name:
Member's Address:
Member's Phone Number:
I do hereby certify that I have taken an "inactive" status. I will be inactive
From:
To:
For the following reasons:
I understand that during the time I am inactive, I am not entitled to receive copies of The Iris or any other mailings from the National Office. In addition, I may not serve as an Officer and/or Committee Chairman or member at either the Local or National level and I may not vote on any fraternity issues.