Groove Phi Groove Social Fellowship Inc.

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Personal Contact Info

First Name:

MI:

Last Name:

Street Address

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Phone:
( ) - ext-

Email Address:

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Emergency Contact:

Emergency Contact Phone:
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Groove Info

Your Groove Name (GKA)

Your Line's Name

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Your Line Number:

Chapter of Initiation

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Dean:

Assistant Dean:

University/College Attended

Degree

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Project G.A.I.N Present Employer:

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Why did you join Groove?:

I hereby understand and accept the below indemnity clause.
Groove Phi Groove Social Fellowship, Inc. prohibits all forms of hazing and/or any acts that may otherwise result in physical and/or mental harm to any individual engaged in an organizational membership orientation or intake programs. All members of the Fellowship understand and acknowledge that they hold the Fellowship free and harmless from any and all liability resulting from their individual behavior in connection with their conduct, behavior or actions involving in the initiation of men into the Fellowship.

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