Change of Chapter Affiliation Online Form

* Please fill out all fields marked with an asterisk

Contact Information

First Name:*

Middle Name:

Last Name:*

Mailing Address

Email Address:*

Country:*

Street Address:*

City:*

State:

Zip Code:*

Library School Information

Institution:*

School:*

Year of Graduation:*

Date of Initiation:*

Position Information

Organization Name:*

Position Title:*

Chapter Information

Current Chapter Affiliation:*

New Chapter Affiliation:*

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