* = Required 1. Your Name *2. Chapter   All members of GBP who gradutate in good standing in the chapter are eligible to receive a small, beautiful seal to affix to their diplomas. Members’ eligibility must be certified by the chapter. Number, and list below in alphabetical order the name of each recipient. Headquarters will send you the appropriate number of seals, along with applications for membership in the Alumni Association, for you to distribute to the individuals. (Membership in the Alumni Association is available to any member of GBP who leaves the chapter in good standing, whether by graduation or otherwise. State the number of persons who should receive AA information BUT NOT DIPLOMA SEALS.) If any member listed has CHANGED NAME since induction, indicate that. Also, if anyone listed TRANSFERRED INTO the chapter, tell us that and the chapter from which he/she transferred. We need to be able to locate each name on the official Headquarters roll. Thanks for your help! *3. Name   4. Name 5. Name 6. Name 7. Name 8. Name 9. Name Send all seals and AA Information to: *10. Address   *11. City, State & Zip