Become a Member

*First Name:
Middle Name:
*Last Name:
Suffix:
Badge or Popular Name:
*Address:
*City:
*State:
*Zip:
Home Phone:
Work Phone:
Mobile Phone:
*Year Initiated into Kappa Sigma:
*Year Graduated from University of Texas :
Membership Fee (Charter Member)	$100.00
Dues - 2005	$100.00
Total Due	$200.00
Scholarship Donation (Voluntary):
Payment Method:
Credit Card:
Card Number:
CVC Code:
*Expiration Date:
*Email Address:
*Choose a password:
*Please enter your password again:

	* denotes required field