Zip Code
Radius (miles)



User Accounts
Username

Password

Re-Enter Password

Personal Contact Info
First Name:
MI:
Last Name:
Street Address

City:
State:
Zip:
Phone:
( ) - ext-
Email Address:
 
Email Confirm:
Emergency Contact:

Emergency Contact Phone:
( ) -
Groove Info
Your Groove Name (GKA)
Your Line's Name
How many in your line?
Your Line Number:
Chapter of Initiation
Current Chapter
Initiation Date
M: D: Y:
Dean:
Assistant Dean:
University/College Attended
Degree
Member Type:
Project G.A.I.N Present Employer:

Profession:

Position

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.
CAPTCHA image
Security Code: