Please take a few minutes and fill out the areas below

to help build up our Alumni Data Base.

Brother's First Name:            

Brother's Last Name:            

Brother's Middle Initial:         

Brother's Initiation Number:   

    First Year Active in AGR:   

    Last Year Active in AGR:   

Brothers Current Address:     

City:                                  

State:                                             Zip   Code:

Brother's Current Phone #:    

Brother's Current Email:        

Brother's Family Members:     

Additional Comments:           

Preferred means of Contact:   Email    Mail    Phone    Crescent    Don't Contact

Thank You For Your Time And We Look Forward

To Talking With You In The Future!!