Chapter Member Directory Request – Sigma Sigma Sigma Chapter – Phi Beta Sigma Fraternity, Inc.

Chapter Member Directory Request

Name(Required)

First Last

Nick name

Email(Required)

Phone(Required)

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Professional Title, Role, or Profession(Required)

Company You Work For or Own(Required)

Industry or Field of Work(Required)

Education Level(Required)

N/A

Bachelors

Masters

PhD

Are you Retired?

Yes

No

Birthdate Month(Required)

Birthdate Day(Required)

Initiation Chapter Name(Required)

Initiation Date(Required)

Wedding Anniversary (if applicable)

Social Media Links (LinkedIn, FB, IG Twitter/X, GitHub, etc.)(Required)

Topics you can speak on or teach(Required)

Professional Interests(Required)

Hobbies(Required)

What information would you like to share with chapter members?(Required)

Are you open to being contacted for mentorship, networking, or collaboration?(Required)

Yes

No

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