Club Registration Form

Club Registration Form

Office of Student Involvement & Leadership Development
Submitting this form confirms your organization's understanding of and agreement to comply with the rules and regulations outlined in the current Synergy Handbook. It is understood that by submitting this form, the organization understands that violation of any rule or regulation may result in the suspension or termination of this body as a registered student organization.
Student Organization*
If you selected "Other" above, please list your organization
Your Name*

First NameLast Name
Your Email*
Please use your worcester.edu email address
Program Coordinator*

Kristie McNamaraLinzy MartinezSarah PotrikusUnknown/New Club
Program Coordinator Email*
example@example.com
President*

First NameLast Name
President Email*
Please use a worcester.edu email address
Vice President

First NameLast Name
Vice President Email
Please use a worcester.edu email address
Treasurer*

First NameLast Name
Treasurer Email*
Please use a worcester.edu email address
Secretary

First NameLast Name
Secretary Email
Please use a worcester.edu email address
Additional Officer

First NameLast Name
Additional Officer Title
Additional Officer Email
Please use a worcester.edu email address
Primary Advisor Name*

First NameLast Name
Primary Advisor Email*
Please use a worcester.edu email address
Have you confirmed with your Advisor that they are willing to serve in this role for the upcoming year?*

YesNo
Additional Advisor Name

First NameLast Name
Additional Advisor Email
Please use a worcester.edu email address

Organization Contact Information

Please complete the details below in order for us to assist students connecting to your organization.
Organization Email Address:
Organization Meeting Day/Time/Location:
Organization Instagram Handle:
Organization Facebook Handle:
Organization Twitter Handle:
Organization Snapchat Handle:
Organization Website:
Other Organization Media:

Reminders

Special Interest Groups and students requesting to form a new student organization must wait to receive approval of this form from Senate before moving forward with club activities. Major Organizations may begin club activities at any time during the semester.
Please click "Submit" to submit your Club Registration Form.
Should be Empty:

Club Registration Form

Organization Contact Information

Reminders

Please click "Submit" to submit your Club Registration Form.