Please fill out the below form and complete as much as possible. If a certain field in the form does not apply to you, please leave it blank. Upon receiving access to the website, you will have the option of updating this information. Make sure that you make note of your username and password. Do not choose a password that anyone else knows because the information contained on this website is fraternity related and not intended to be public knowledge.

Enter your Scroll Number as your Username
Username:

Password has a maximum size of 10 characters
Password:       Enter Password Again:

You must enter your name and email address to create an account.
Please enter your full name
Name:
E-Mail Address:
Address:
City:       State:       Zip:

You must provide us with at least one phone number to verify your account.
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Pager Number:
Fax Number:

Info about Next of Kin(s):
Name(s):
Phone#:       Phone#:
Address:
City:       State:       Zip:

Info about Where You Work:
Company Name:
Title at Company:

Additional Info:
Nickname:
Big Brother:
Your Wife's Name:

You Must Enter Your Birthdate. If you accidently enter an incorrect birthdate, contact the administrator to change it.
Your Birthdate: