Replacement or Correction Certificate Request Form

Members or chapter advisors may use this form to request a replacement or correction certificate for members already reported to International Headquarters. There may be a fee associated with a replacement certificate. Delivery time for replacement certificates is 7-10 days.

Name as reported to Headquarters when inducted:

Membership identification number:

College Name:

Chapter Name:

Induction Date:

Email Address:

Phone Number:

Name as it should appear on the new certificate:

New certificate should be mailed to:

Address:

City:

State:  

Zip Code:  

Is this a new address? Yes   No

Why are you requesting this replacement certificate?

Please note: Membership Identification Cards are attached to membership certificates.