Fillable Application-to-start-a-chapter-or-club Chapter and Club Annual Renewal Packet

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Application-to-start-a-chapter-or-club Chapter and Club Annual Renewal Packet

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Application to Create a
New Alumni and Friends
Chapter or Club
2625 East Matoian Way
Fresno, CA 93740-8000
559.278.2586 main
559.278.6790 fax
Fresnostatealumni.com
1
TABLE OF CONTENTS
Application Process and Checklist ......................................................................................................... 2
Proposed Chapter or Club Name ........................................................................................................... 4
Chapter/Club Purpose and Activities ...................................................................................................... 5
Declaration and Indemnification Policy Agreement and Officer Renewal ............................................... 6
Authorized Account Signers ................................................................................................................. 13
Annual Officer Meetings and Planned Events ...................................................................................... 14
Campus Acknowledgement of Chapter or Club.................................................................................... 16
List of Interested Participants ............................................................................................................... 17
2
Application Process and Checklist
PROCESS
Please submit this completed application to the appropriate FSAA staff member. As per the
Chapter/Club Policy and Resource Guide, the following process is followed in establishing any new
alumni and friends chapter or club.
Please feel free to schedule meetings, phone calls, etc., to ask any questions you may have about this
process.
1. Once the application is completed, submit to the appropriate FSAA staff member and schedule
a meeting to review the information. All leadership of the proposed new chapter or club must
participate in the meeting(s) with FSAA staff.
a. Other individuals who wish to support the chapter/club, but who are not part of the
leadership team, may also join the meetings.
2. The purpose of the meetings is to:
a. Review the application to ensure all information has been completed fully and
accurately.
b. Enable FSAA staff to fully educate and inform individuals of the purpose of
chapters/clubs, and ensure alignment with the strategic plan and goals of the FSAA.
c. Answer any and all questions individuals may have about the FSAA, its policies and
procedures, operational questions about chapters/clubs, best practices, start-up
strategies, etc.
3. Approval process
a. Once the FSAA staff member has reviewed and approved the “New Chapter or Club”
application and “Annual Renewal Packet”, they will submit to the Engagement
Committee (a sub-committee of the FSAA’s Board of Directors).
b. The Engagement Committee will review and recommend for approval by the Executive
Committee.
c. Upon approval by the Executive Committee, the proposal will be approved by the entire
FSAA Board of Directors at the next Board of Directors meeting. These meetings are
held on a quarterly basis.
4. After the chapter/club is approved:
a. Chapter/Club leadership will be notified.
b. The FSAA will create an account for any financial holdings.
c. An official chapter/club logo will be created and provided to the designated leadership.
d. A meeting will be scheduled between relevant FSAA staff and the leadership to go over
any additional/final details.
e. The new chapter/club will be announced at the next soonest FSAA Chapter/Club
Leadership meeting (held three times each year).
Please see the Chapter and Club Policies and Resource Guide for additional guidance.
3
HOW TO COMPLETE THIS APPLICATION
1. This PDF is interactive, enabling you to type/enter in much of the required information.
2. Signed copies: The packet should be completed in its entirety first, typing in all of the required
information. Once that information is completed, print the packet and provide to each individual
so they sign where required. This is best accomplished during one of your Executive Committee
meetings, when all officers and board members are present.
3. Once completed, the document may be scanned and emailed to the Director of Engagement
(Matthew Schulz; mschulz@csufresno.edu
). The completed packet may also be mailed or
delivered in person (see address on coverpage).
CHECKLIST
Document
Completed
1. Proposed Chapter or Club name
□
2. Chapter/Club Purpose and Activities
□
3. Declaration and Indemnification Policy Agreement and Officer Renewal
□
4. Authorized Account Signers
□
5. Annual Officers Meetings and Planned Events
□
6. Chapter or Club Campus Acknowledgement
□
7. List of Interested Participants
□
4
Proposed Chapter or Club Name
Instructions:
1. Please indicate below the proposed name of your chapter or club.
2. Reminder:
a. Chapters are academically-based, something you can obtain a degree in.
b. Clubs are non-academically-based, some other “tie that binds” (example: Hmong Alumni
Club, Band Club, etc.)
3. Please see the Chapter/Club Policy and Resource Guide for additional guidance.
Date Prepared: _____________________________________________________
Proposed Chapter/Club name: _____________________________________________________
5
Chapter/Club Purpose and Activities
Please answer the questions below. Submit on a separate sheet of paper (typed, not handwritten).
1. What is the purpose of your chapter or club? What would you like to accomplish?
2. How will your activities create or support meaningful engagement for alumni and friends of
Fresno State and support current students? Stated differently, how does your proposed alumni
chapter/club connect back to Fresno State?
3. What kinds of activities do you plan on doing each year? Please list all activities you would like
to engage in. Below is a list of common/suggested items many other chapters/clubs perform. It
is suggestive, but not comprehensive. If there are other kinds of activities please indicate.
a. Start a scholarship
b. Networking/Industry events
c. Support a college/major/program/student club/organization on campus.
d. Fundraising events
e. Tailgate
f. Professional development seminars/workshops
4. Assuming your chapter/club is approved, what are your first year goals? Second year goals?
6
Declaration and Indemnification Policy Agreement and
Officer Renewal
Chapter/Club Name:
____________________________________________________________
Date Prepared:
____________________________________________________________
DECLARATION:
As the officers of the above referenced constituency alumni group (Organization), we, the undersigned,
understand and agree to abide by the following:
1. The Organization agrees to conduct itself in a manner consistent with the goals, objectives, and
standards of the Fresno State Alumni Association (FSAA) and California State University,
Fresno (Fresno State).
2. The Organization does not discriminate on the basis of race, color, national origin, religion, sex,
gender, sexual orientation, Veterans’ status, disability or political affiliation.
3. The Organization will abide by the policies and procedures set forth by the FSAA and Fresno
State.
4. The Organization recognizes that the pronouncements can be made only in the name of the
Organization, rather than in the name of the FSAA and/or Fresno State.
5. The Organization recognizes that the FSAA and Fresno State are not responsible for financial
commitments and obligations of the organization.
INDEMNIFICATION STATEMENT:
The Organization hereby agrees to indemnify, defend and hold harmless the FSAA; Fresno State;
California State University, Fresno Foundation; The Trustees of the California State University; and all
employees or agents of the foregoing from any damages incurred during an Organization event.
7
We, the officers (aka Executive Committee) of the Organization, have received and have reviewed all
relevant FSAA policies and procedures. We hereby attest, in the name of our Organization, that its
governing body, now and in the future, accepts responsibility for complying with these and other
pertinent policies and procedures of FSAA and California State University, Fresno.
In instances where our Organization has a board in addition to the Executive Committee, all board
members who names and signatures are included in this document also agree to the statement above.
Instructions:
1. Officers and/or board members are voted on and approved each spring. Their term does not
begin until the new fiscal year (July 1).
2. Inaugural elections for chapters/clubs (in their first year):
a. President and Vice President serve two-year terms.
b. The Secretary and Treasurer serve a one-year term.
c. This establishes a staggered rotation among the Executive Leadership team.
d. In each succeeding election (year two and thereafter), officers are elected to serve a
two-year term.
3. Officers must be unique individuals. No one person may serve in more than one position.
4. Titles for officers are designated by the FSAA and are to remain unchanged.
5. Campus Liaison: This is a required officer position, to be filled by Fresno State faculty or staff.
6. All officer positions must be filled before any other position is created.
7. All sections below must be completed in full. So that other alumni and friends can easily find
and contact Chapters and Clubs, the names, email and phone numbers for officers and board
members are published on the FSAA website.
OFFICERS (Executive Committee)
PRESIDENT
Name: ____________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: ________________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
8
VICE PRESIDENT
Name: ____________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: ________________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: ________________________________________________
SECRETARY
Name: ____________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: ________________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: ________________________________________________
TREASURER
Name: ____________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: ________________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
9
CAMPUS LIAISON (note: this position must be filled by a Fresno State faculty or staff member)
Name: ____________________________________________________________
Department: _______________________________ Title: _________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _______________________________
10
BOARD MEMBERS
Instructions:
1. If your organization has a formally designed board, use the following pages to list their titles and
provide all of their information.
2. If you do not have any board members, select the box below and skip to the next section.
3. Term limits apply to board members as well.
Our Organization does not have a board.
TITLE:
________________________________________________
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
TITLE:
________________________________________________
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
TITLE:
________________________________________________
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
11
TITLE:
________________________________________________
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
TITLE:
________________________________________________
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
TITLE:
________________________________________________
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
TITLE:
________________________________________________
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
12
TITLE:
________________________________________________
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
TITLE:
________________________________________________
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
TITLE:
________________________________________________
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
TITLE:
________________________________________________
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
13
Authorized Account Signers
Chapter/Club Name:
___________________________________________________
Date Prepared:
____________________________
Effective Date:
New signers are effective as of the date the organization is approved.
Instructions:
1. A minimum of three (3) account holder/signers is required.
2. All individuals possessing account holder/signer privileges must complete the fields below.
3. An account holder/signer does not have to be an officer of the Chapter or Club.
AUTHORIZED SIGNER #1 (Must be the Treasurer)
Date: ___________________________________
Print name: _________________________________
Signed:
___________________________________
AUTHORIZED SIGNER #2
Date: ___________________________________
Print name: _________________________________
Signed:
___________________________________
If individual is not an officer, the information below must be completed:
Address: ________________________________ City: _______________ State: _____ Zip: ______
Phone: __________________________ Cell Home Work
Email: _________________________________________________
AUTHORIZED SIGNER #3
Date: ___________________________________
Print name: _________________________________
Signed:
___________________________________
If individual is not an officer, the information below must be completed:
Address: ________________________________ City: _______________ State: _____ Zip: ______
Phone: __________________________ Cell Home Work
Email: _________________________________________________
AUTHORIZED SIGNER #4
Date: ___________________________________
Print name: _________________________________
Signed:
___________________________________
If individual is not an officer, the information below must be completed:
Address: ________________________________ City: _______________ State: _____ Zip: ______
Phone: __________________________ Cell Home Work
Email: _________________________________________________
14
Annual Officer Meetings and Planned Events
Chapter/Club Name:
____________________________________________________________
As all Chapters/Clubs are provided liability insurance coverage under the FSAA’s insurance policy, and
so that the FSAA can provide logistical and marketing/promotional assistance for the events planned by
your Chapter/Club, please complete the two sections below and return to the FSAA.
SECTION 1: Officer/Board Meetings
Chapters/Clubs should hold a minimum of four meetings per year. Below please indicate the
dates/times/locations you are currently anticipating holding your officer/board meetings.
Date
Time
Location
SECTION 2: Events/Activities Planned
EVENT #1
Date: _________________________ Time: _____________ # of Guests (estimate): ___________
Event name: ________________________________________________ Alcohol present?
Yes No
Location: ________________________________________________ Fee to attend?
Yes No
Description: ________________________________________________ If yes to fee, amount: $__________
_________________________________________________________________________________
_________________________________________________________________________________
Event type:
Social/Mixer – Alumni/Friends only Fundraiser – General
(check all that apply)
Social/Mixer – Alumni/Friends & students Fundraiser – Scholarship endowment
Educational event Other: __________________________________
Do you plan on including a silent auction at your event?
Yes No
Do you plan on including a raffle (opportunity drawing prize) at your event?
Yes No
Budget:
Expected Income: $_______________
Expected Expenses: $_______________
Expected Net profit: $_______________
15
EVENT #2
Date: _________________________ Time: _____________ # of Guests (estimate): ___________
Event name: ________________________________________________ Alcohol present?
Yes No
Location: ________________________________________________ Fee to attend?
Yes No
Description: ________________________________________________ If yes to fee, amount: $__________
_________________________________________________________________________________
_________________________________________________________________________________
Event type:
Social/Mixer – Alumni/Friends only Fundraiser – General
(check all that apply)
Social/Mixer – Alumni/Friends & students Fundraiser – Scholarship endowment
Educational event Other: __________________________________
Do you plan on including a silent auction at your event?
Yes No
Do you plan on including a raffle (opportunity drawing prize) at your event?
Yes No
Budget:
Expected Income: $_______________
Expected Expenses: $_______________
Expected Net profit: $_______________
EVENT #3
Date: _________________________ Time: _____________ # of Guests (estimate): ___________
Event name: ________________________________________________ Alcohol present?
Yes No
Location: ________________________________________________ Fee to attend?
Yes No
Description: ________________________________________________ If yes to fee, amount: $__________
_________________________________________________________________________________
_________________________________________________________________________________
Event type:
Social/Mixer – Alumni/Friends only Fundraiser – General
(check all that apply)
Social/Mixer – Alumni/Friends & students Fundraiser – Scholarship endowment
Educational event Other: __________________________________
Do you plan on including a silent auction at your event?
Yes No
Do you plan on including a raffle (opportunity drawing prize) at your event?
Yes No
Budget:
Expected Income: $_______________
Expected Expenses: $_______________
Expected Net profit: $_______________
16
Campus Acknowledgement of Chapter or Club
Instructions:
1. In order for the FSAA Board of Directors to officially recognize the Organization for the
upcoming fiscal year, this Statement of Acknowledgement form must be signed by a campus
representative.
2. By signing, the campus representative is acknowledging that the Organization represents an
alumni constituency group that the campus representative is involved with on campus.
3. For Chapters: This form must be signed by the Dean, Associate Dean, or their designee, of the
college under which the Chapter’s major is issued.
4. For Clubs: This form must be signed by a relevant and appropriate Fresno State faculty or staff
member who is actively involved with the constituency group the alumni club represents.
Chapter/Club Name:
____________________________________________________________
Date Prepared:
____________________________________________________________
The efforts of this Fresno State Alumni Association constituency group are officially recognized, as they
seek to further the interests of California State University, Fresno.
Print name:
_______________________________________________
Title:
_______________________________________________
College/School:
_______________________________________________
Department:
_______________________________________________
Signature:
_______________________________________________
Date:
_______________________________________________
17
List of Interested Participants
In addition to the officers (required) and board members (optional), to help ensure the chapter/club gets
off to a healthy start once approved by the FSAA Board of Directors, you are also required to have at
10-15 additional individuals who have indicated their active interest in supporting/participating in the
chapter/club.
On the following sheet of paper please provide their information.
18
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
19
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
20
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
21
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
22
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
Yes! I am interested in joining and supporting the _________________________________________ chapter/club.
Name: ________________________________________________________________
Affiliation:
Alum grad Alum non-grad Friend
Class year: ____________
Term:
1
st
2
nd
3
rd
Year in current term:
1
st
2
nd
Address: _______________________________ City: _______________ State: ____ Zip: ______
Phone 1: __________________________ Cell Home Work
Phone 2: __________________________ Cell Home Work
Email: _________________________________________________
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Application-to-start-a-chapter-or-club Chapter and Club Annual Renewal Packet

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Completed 2 May 2020

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