| Name: |
___________________________________________________ |
| Address: |
___________________________________________________ |
| City: |
___________________________________________________ |
| Zip Code: |
___________________________________________________ |
| Phone Number: |
___________________________________________________ |
| Email Address: |
___________________________________________________ |
| GWC I. D. Number: |
___________________________________________________ |
| What clubs are you interested in? |
___________________________________________________ |
|
___________________________________________________ |
|
___________________________________________________ |
| Do you have an idea for a new club? |
___________________________________________________ |
|
___________________________________________________ |
|
___________________________________________________ |
| Would you like information about student government at GWC? |
YES _____ NO _____
|
| Signature: |
___________________________________________________ |
| Date: |
___________________________________________________ |