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Title


Registration Type


Semester


Date Received

Select a date from the calendar.

Club Name


Meeting


Club Website

Type the Web address: (Click here to test)  

Type the description: 

Club Email


Elections

Select a date from the calendar.

Officers Elected?

President

First Name


Last Name


SS#


Street Address


City


State


Zip


Ph#


Email


Info Authorization

Vice-President

First Name


Last Name


SS#


Street Address


City


State


Zip


Ph#


Email


Treasurer

First Name


Last Name


SS#


Street Address


City


State


Zip


Ph#


Email


Secretary

First Name


Last Name


SS#


Street Address


City


State


Zip


Ph#


Email


Advisor

First Name


Last Name


Department


Mail Code


Room#


KCC Ph. Ext.


Email


Previous Service

How Long


Guidelines

Attachments