Form R - Request for Certificate of Merit

Certificates are $10.00 U.S. each. Please call International Headquarters at 1-800-368-5606, Monday - Friday, 8:00 a.m. to 5:00 p.m. Eastern Time with your payment information.
Magister
Name*:
Address*:
Dates Served (month/yr- month/yr)*:
Vice-Magister
Name*:
Address*:
Dates Served (month/yr- month/yr)*:
Clerk
Name*:
Address*:
Dates Served (month/yr- month/yr)*:
Exchequer
Name*:
Address*:
Dates Served (month/yr- month/yr)*:
Historian
Name*:
Address*:
Dates Served (month/yr- month/yr)*:
Other (Faculty Advisor, Alumni, etc)
Name:
Address:
Dates Served (month/yr- month/yr):
Tel.1-800-368-5606
Fax1-202-223-6808
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