Join Life Loyal Today


Join thousands of Life Loyal Tri Deltas by completing this registration form.

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Enter all the information, then hit submit.  For more information about Life Loyal, contact us at LifeLoyal@trideltaeo.org.

 
First Name*
Middle Name*
Maiden Name
Last Name*
Name as you wish for it to appear on membership card*
How did you learn about Life Loyal?*
If other, where?
Is this a gift for your daughter?* Yes
No
If so, is your daughter graduating this year? Yes
No
Would you prefer a Life Loyal badge or a Life Loyal charm?* Life Loyal Badge
Life Loyal Charm
Free gift.* Jewelry Box
Luggage Tag
College/University*
Initiation Year*
Shipping Address (No PO Boxes)*
Apartment/unit number
Shipping City*
Shipping State*
Shipping Postal Code*
Email*
Phone Number*
Thank you for your payment of
1 single payment of $295.00
12 monthly payments of $29.00
Comments
Billing Name
Billing Address
Billing City
Billing State
Billing ZIP Code
Billing Country
Card Number (do not include spaces or dashes)
Expiration Date (mm/yy)
Security Code What's this?





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