Name of Organization: ________________________________
College and Location: ________________________________
Contact Person: Name: ________________________________
E-Mail: ________________________________
Number of Members: ________________________________
Organization Founded: ___ day _________ month _____ yr
Status with College/University (if applicable):
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Officers:
Position/Title Name
_________________________ __________________________
_________________________ __________________________
_________________________ __________________________
_________________________ __________________________
_________________________ __________________________
WWW Site(s): __________________________________________
__________________________________________
Postal Address: _______________________________________
_______________________________________
_______________________________________
Describe the group (purpose, focuses, activities):
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
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