Annual Registration Form

Student Organization’s (Official) Name: Click here to enter text.

President’s Information

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First Name

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Net ID Number

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Permanent Address

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Permanent City, State and Zip

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Permanent Phone

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Last Name

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Email Address

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Local Address

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Local City, State & Zip

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Local Phone

Moderator’s Information

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First Name	Last Name	Department

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Campus Address	Campus Phone	Email Address

Web page

Does your organization have a web page?	YES NO

If yes, what is the web address for it? Click here to enter text.

Would you like it linked to your organization’s information on the Student Activities Web page? YES NO

Signatures

Please print and sign.

I certify that the above information is correct. I give the Student Activities Office permission to post my email address on the Student Activities webpage and have it added to the Presidents’/Moderators’ Listserve. I also realize that executive officers must maintain a cumulative QPA of 2.5 or its equivalent and that grades will be reviewed each semester.

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Student Organization President Signature	Date

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Student Organization Moderator Signature	Date

FILL IN ALL FIELDS FOR ALL OFFICERS DESCRIBED IN YOUR ORGANIZATION’S CONSTITUTION Original signatures are required All Officer Q.P.A.s will be checked (according to the Student Handbook Policy) Your Net ID is your initials plus 5 numbers; it can be found on your Student ID Card.

Position/Title	Typed Name	Signature (handwritten signature required)	Net ID Number