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Club & Organization Registration Form
Student Activities Office * Parsons Union Building* Lock Haven University
2018-2019
Club/Organization Name: _____________________________________________________________
Meeting Day: _______________________________ Meeting Time: ___________________________
Meeting Location: ____________________________ Total Number of Club Members: __________
Does your club charge membership dues: □ Yes □ No If Yes, enter amount _____________
Release of Information & statement of non- discrimination:
By signing this form, this organization, its subordinate bodies, officers, and advisors agree to abide by all
applicable federal and state laws; University and University related rules, regulations, and policies; and
all University policies. Furthermore, we shall not discriminate on the basis of race, color, age, religion,
veteran’s status, sex, national origin or disability in our educational programs or activities.
We also grant permission to the Student Activities Office to verify contact information, academic status,
and disciplinary status as it pertains to this student organization. We further understand that contact
information may be provided to other parties that have an interest in the development or, or can
provide legitimate services for the organization.
Accounts:
The Student Activities Office is authorized to recognize the signatures within this document for
withdrawal of funds or for transactions of any other business of the student organization specified on
this form. It should be understood that it is the treasurer’s responsibility to record transactions and
maintain the organization’s registered accounts with the Student Activities Office. The advisor,
President, and Treasurer of the organization are required to sign all vouchers. By signing this form, each
officer and advisor affirms that he/she understands these responsibilities and agrees to carry out the
responsibilities assigned. A new form must be submitted each time any information on this form
changes.
Officers:
The following students will be recognized as the primary contacts for the organization listed above and
accorded responsibilities and privileges offered by the University. Student leaders must list their Lock
Haven University email address. All officers must have at least a 2.0 cumulative grade point average,
unless otherwise stated in club constitution to be eligible. By signing below, I certify that I have read the
Universities policy on hazing in the student handbook and that I will make the content of the policy
known to current and potential members of the organization.
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