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1. First name *
2. Last name *
3. Maiden name (if applicable)

1. Address *
2. City *
3. State * select AL - Alabama AK - Alaska AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DE - Delaware DC - District of Columbia FL - Florida GA - Georgia HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MD - Maryland MA - Massachusetts MI - Michigan MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York NC - North Carolina ND - North Dakota OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VT - Vermont VI - Virgin Islands VA - Virginia WA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming
4. Zip *
5. Phone
6. Email *

1. School attended *
2. Years attended *
3. Pastor first name *
4. Pastor last name *
5. Degree/major
6. Highest degree earned select Associate's (2-year) Bachelor's (4-year) Master's Doctorate Post-Doc

1. Current career
2. Birthday

3. Occasionally another Chi Alpha alumnus may ask for your current address/phone number. Do we have your permission to provide them with your current information?

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