Mt. San Jacinto College
Student Government Association
CLUB MEMBERSHIP FORM
Please Print
(Note: A campus club MUST have 5 student members to be approved)
Name of Club: __________________________________________ Academic Year: ___________________
Club Meeting Time: __________________________________________ Club Email: ______________________
Advisor Name: ______________________________________________Email: ______________________
Members/Officers
E-Mail Address
Opt out of SLDP emails* SGA Sticker # Student ID #
___________________________ ________________________ ___________________ ____________ _______________
President or Equivalent
______________________________ ___________________________ _____________________ ______________ ________________
Vice President or Equivalent
______________________________ ___________________________ _____________________ ______________ ________________
Secre
tary or Equivalent
______________________________ ___________________________ _____________________ ______________ ________________
Treasurer or Equivalent
______________________________ ___________________________ _____________________ ______________ ________________
ICC Repre
sentative
Please list all club members.
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_____________________________ ___________________________ _____________________ _____________ __________________
______________________________ ___________________________ _____________________ ______________ __________________
______________________________ ___________________________ _____________________ ______________ __________________
______________________________ _________________
__________ _____________________ ______________ __________________
______________________________ ___________________________ _____________________ ______________ __________________
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_____________________________ ___________________________ _____________________ ______________ __________________
______________________________ ___________________________ _____________________ ______________ __________________
______________________________ ___________________________ _____________________ ______________ __________________
______________________________ ___________________________ _____________________ ______________ __________________
_____________________________ ___________________________ _____________________ ______________ __________________
For addit
ional members, please attach additional club membership forms.
*A
ttention Club Members: Your email will be subject to recieve limited updates from the Student Life & Devlopment Program offices. If you
would not like to recieve emails please put a check mark in the "Opt out of SLDP emails".
Advisor Title: Assoc. Faculty/ Full-time Faculty/ Administrator/Other Phone Number/ Extension: ______________________
Members/Officers
E-Mail Address
Telephone Number SGA Sticker # Student ID #
