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9501 Northwest 86th Terrace
Kansas City, MO 64153
(866) 342-6627
membership@xigammaphi.org

Membership Application

Please complete the form below and we will contact you right away.

Membership Application

Personal Information

First Name:*

Last Name:*

Middle Initial:*

Email Address:*

Permanent Street Address:*

City:*

Zip Code:*

Country:*

State:*

Province:*

Home Phone:*

Cell Phone:*

Date of Birth:*

Branch of Military:*

Enlistment Date:*

Discharge Date:*

Type of Discharge:*

Emergency Contact Name:*

Relationship:

Phone Number:*

Affirmation Statement

Are you a member of another non-profit organization? :

Yes No

Please List the Organization(S):

Criminal History

Have you ever been convicted of a crime other than a misdemeanor traffic offense?:

Yes No

Please Explain:

In the event, upon acceptance as a member of Xi Gamma Phi Military Sorority, Inc., if anything should change concerning a criminal record, the Compliance Officer must be notified within 24 hours of the alleged charge and not the conviction.

Initials:

Once the final disposition of the case has been reached, the Compliance Officer must be notified of the results with 24 hours

Initials:

I, have read and understand the requirements asked of me by Xi Gamma Phi Military Sorority, Inc., pertaining to my involvement or any new criminal charges. I also understand that if my application is approved, I will need to pay annual dues in an amount that will be disclosed upon acceptance notification.

I understand that falsification of any information on this application or attachments will eliminate me from being considered for membership into Xi Gamma Phi Military Sorority, Inc. By signing this form, I verify that all the information I have provided is true and correct. I understand that at any time, Xi Gamma Phi Military Sorority, Inc can rescind any rights or privileges to an applicant based on the submission of false information or documents

Initials:

Upload Files:

Documents Needed: Redacted DD 214 - Proof of Service or LES (Please blacken out any PII on these documents, ie., SSNs)

Max upload file size 5MB. Allowed File Type - jpg, .jpeg, .pdf, .doc, .docx.