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 Name:____________________________________________________ CHAPTER:________________________________________________ Street Address:___________________________________________________ City:_______________________ State:___________ ZIP:___________ Send this form with payment by personal check or money order made out to Eta Sigma Phi (no cash or credit card, sorry) to: 
            Dr. Thomas J. Sienkewicz 
            For questions: toms@monm.edu. Sorry, only one check or money order per order form. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||