Gamma Theta Upsilon Honor Society

Initiate Report and Address Form

Reporting of Initiates to Executive Secretary

Please read carefully before filling in this form! Check for errors before continuing to the next page.

Arrange names in “alphabetical order” and give names exactly as wanted on the Certificates. Chapter numbers are assigned by local Chapter. The Executive Secretary will assign each an International Number. Do not omit the date of initiation. Regular and Honorary membership dues of $40.00 per initiate must be submitted as a single online payment or as a total sum in a single check made out to: Gamma Theta Upsilon; individual student checks will not be accepted and will be returned.

The printed form and the check should be sent to the Executive Secretary at the address on the next page. A copy of the initiate report with the International Numbers will be returned to the chapter and must be kept in its file.

*required fields

Chapter*
Institution*
Department

Full School Address*

Initiation Date*
Number of Memberships*: Regular Honorary

Chapter #	Name of Initiate*	Membership Class	Dues

			$40.00
Home Address*:	**See notes	Graduation:	per initiate
	**See notes	Parent's address†
Email*:		Parent's address†


Home Address*:		Graduation:
		Parent's address†
Email*:		Parent's address†


Home Address*:		Graduation:
		Parent's address†
Email*:		Parent's address†


Home Address*:		Graduation:
		Parent's address†
Email*:		Parent's address†


Home Address*:		Graduation:
		Parent's address†
Email*:		Parent's address†


Home Address*:		Graduation:
		Parent's address†
Email*:		Parent's address†


Home Address*:		Graduation:
		Parent's address†
Email*:		Parent's address†


Home Address*:		Graduation:
		Parent's address†
Email*:		Parent's address†

Click Continue to create the complete printable form with an initiate eligibility statement that must be signed. Submitting an unsigned form will delay processing of new initiates.

PDF versions
Initiate Report Form
Initiate Address Form
Parents' Address Form

*Required fields

**Give the address to which each wants THE GEOGRAPHICAL BULLETIN and other communications sent. It is important that this be an address that can be used for at least two years and the initiate is encouraged to give a permanent home address. Note also that the anticipated date of graduation is requested for each.

†Parent's addresses (if given) may be supplied to third party retailers of GTU merchandise.

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Initiate Report and Address Form