*REQUEST (Please check one or more):

	Send me a FREE Sigma Nu Fraternity Info CD mailed to me
	Send me information on your Incoming Student $500 Scholarship
Please contact me next Fall semester when I start school at Southeast
Please contact me so I can meet/talk to you guys. Contact me via: Phone E-mail

INFORMATION

*First Name:
*Last Name:
*Address:
*Primary Phone:
Secondary Phone:	(this could be your dorm room number)
*E-mail Contact:

ADDITIONAL INFORMATION
Are you currently attending Southeast Missouri State University? Yes
If so, what year are you? (Freshman, Sophomore, etc.)

Are you a currently in High School? Yes
If so, which High School?

Are you a Legacy? Yes
If so, explain:

Additional Comments:

* = Required Information

You will receive confimration via the e-mail address you provided that your request has been received and is in process.