Member Request Form
Fill out the form carefully for registration
Student Name
First Name
Middle Name
Last Name
Pronouns
N/A
He/Him
She/Her
He/They
She/They
They/Them
Student E-mail
example@massbay.edu
Student ID
Alternate E-mail
example@example.com
Do you wish to receive Teams Notifications?
Yes
No
Do you wish to receive Club Emails and Updates?
Yes
No
Do you wish to receive Club Text Messages?
Yes
No
Program of Study
Please Select
Accounting
Automotive
Business
Biology
Biotechnology
Communication
Computer Science
Criminal Justice
Education and Human Services
Electronics
Engineering
English
Environmental Science
Forensics
General Studies
Hospitality
Health Sciences
Humanities
Legal Studies
Liberal Arts
Mathematics
Network Systems
Radiologic technology/science - radiographer
Social Sciences
STEM (General)
Undeclared
What are you studying?
Meeting Time Preference
Monday: 1pm
Tuesday: 3pm
Tuesday: 4pm
Wednesday: 1pm
Thursday: 1pm
Thursday: 2pm
Thursday: 3pm
Fri: 2pm
Fri: 3pm
Fri: 4pm
Fri: 5pm
Fri: 6pm
Sat: 2pm
Sat: 3pm
Sat: 4pm
Sat:5pm
Sat: 6pm
Sun: 2pm
Sun: 3pm
Sun: 4pm
Sun: 5pm
Sun: 6pm
Phone Number
Please enter a valid phone number.
Any Questions?
Additional Information
Submit
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