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DDE International Chapter Membership Application
Full Name of Institution *
Address*
Street Address *
Street Address Line 2
City *
Postal / Zip Code *
State / Province / Region *
Country *
Approximate Number of Students in Program
Is your program accredited by FEPAC? *
What degrees are offered?
Program Website *
Contact Person *
First *
Last *
Position with Program
Email *
Phone (Including country code)
Chapter Statement:
I hereby acknowledge an invitation to become an International Chapter of Delta Delta Epsilon
Date *
Print Your Name for Signature *
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