[heading "Your Information"]
First Name
* Middle Name
Last Name
* Email Address
* Address 1
* City
* Zip
* Check OneFall TermSpring Term
* Chapter —Please choose an option—Chain O' LakesC.C. ReevesClioLiv CoPort HuronRiver RaisenRosevilleWalt DisneyWayne
* State AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming
* Phone
* Installation Date
[heading "Proposed Chapter Budget"]
* Fund Raising
* Initiation Fees
* Gifts
* Other Income
Total Income[calculated total-income "(fund-raising + initiation-fees + gifts + other-income)"]
* Prospect Parties
* Fun Events
* Michigan and ISC Fees
* Other Expenses
Total Expenses[calculated total-expenses "(parties + isc-fees + events + other-expenses)"]
Net Gain / Loss[calculated gain-loss "(total-income - total-expenses)"]
I certify that the information submitted in this form is true and correct to the best of my knowledge.