Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
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First Name
Last Name
Date of Birth
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Area Code
Phone Number
Email
*
example@example.com
Branch of Service
*
Status
*
Length
*
Discharge type
*
Highest level of Education
*
Current or Previous member of another military Greek letter sorority/fraternity? (Yes/no; if yes, which organization)
*
Were you referred by a member of Mu Beta Phi Military Fraternity Inc.? (Yes or No)
*
If yes who?
Why do you want to join Mu Beta Phi Military Fraternity, Inc?
*
Have you ever been convicted of a crime? (yes/no) If yes: when and explain
*
By putting my initials below I hereby certify that the information provided is true and accurate to the best of my knowledge. If any information is found to be false, it may disqualify me as a candidate.
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