DEPLEDGE FORM

Use this form to report any pledges who will not be continuing on to Initiation.

As a reminder, Pledge Fees/Health & Safety Surcharge Fees ($85) are not refundable.

Any Lifetime Fees/Health & Safety Surchage Fees ($290) are refundable upon request. Refunds will be issued via the same payment method they were paid to the National Office. Please allow 7 business days for refunds to appear.

Name of person completing this form *

Your email address *

Chapter Name *

What office do you hold? *

How many depledges are you reporting? *