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Revised 07/03/17
Club Registration Form
* This form must be submitted each semester for club to remain active *
Club Information
Name of Club:
Today’s date:
Type of Club:
Academic
Activism/Awareness
Business
Community Service
Creative & Performing Arts
Cultural/Multicultural
Environmental
Governing Councils
Health
Honorary
Media/Journalism
Recreation
Religious/Spiritual
Special Interest
Sport Clubs
New Club Existing Club Inactive Club wanting to be reactivated
Advisor
Advisor:
Advisor School Email: Advisor Office Phone Number:
Advisor Office Number (and
building):
Secondary Advisor
Secondary Advisor (if
applicable):
Advisor School Email: Advisor Phone Number:
Advisor Office Number (and
building):
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Revised 07/03/17
Membership Dues
Will this club collect membership dues?
Yes No
If so, how much?
Members
List four (4) students, preferably officers who will be members of the club:
Name School Email Position (if applicable)
FOR OFFICE USE ONLY
Programming Specialist Signature:
Date:
Approved Not Approved
Director of Student Life Signature:
Date:
Approved Not Approved