LAMBDA CHI ALPHA FRATERNITY

54th General Assembly

Nomination for the Order of Merit

Note: The Order of Merit recognizes alumni brothers for outstanding, lengthy, and dedicated service – particularly at the local chapter level. This is Lambda Chi Alpha’s greatest award for volunteer service. Please feel free to attach additional information or a biography of the nominee.

Name of Nominee: / Age: / Zeta No.:
Initiating Chapter: / School: / Grad Yr.:
Home Address:
(Street) / (City) / (St./Prov.) / (Zip/PC)
Email:
Business Firm:
Title or Position:
Business Address:
(Street) / (City) / (St./Prov.) / (Zip/PC)
Business Phone: / ( ) - / Cell / Home Phone: / ( ) -
When did he become associated with your chapter?

In what capacities? Check all appropriate boxes and fill in the blanks.

High Pi for period of / to
Alumni Advisory Board for period of / to
House Corporation for period of / to
in the offices of
Alumni Association for period of / to
in the offices of
Financial Adviser for the period of / to
Faculty Adviser for the period of / to
Active in house building or purchase program
Explain:
Active assistance in chapter recruitment from / to
Explain:
Chapter, alumni organization, or individual submitting nomination:
Signed: / Date: / / /
(President of chapter, alumni organization, or individual submitting nomination)

**Nomination DEADLINE: March 1, 2012**

Mail entry to: Lambda Chi Alpha, ATTN: Marilyn Barnard, 8741 Founders Road, Indianapolis, IN 46268

09-2011