New Member* Information

please print (its only 1 page) and bring along with your membership due

First Name: ________________________ Last Name:________________________   M   or   F    

Address: ___________________________________________________________________

Phone Number:   (     )                          E-mail: ______________________________________

School Year:   1   2   3   4+   Graduate

Major(s) and Minor(s):   ___________________________________________           

What days are you on campus? ____________________________________________

Would you be interested in holding a club position in the future (President, Vice President, Secretary, Treasurer, Historian)?      YES         NO         MAYBE  

How did you hear about CSULB’s Environmental Science &Policy  Club?  

__________________________________________________________________________

Any additional information you would like to share with us?

___________________________________________________________________________

Release of Liability

In consideration of my participation in any and/or all Environmental Science and Policy activities, I assume any and/or all responsibility in association with my participation in any and/or all activities. I release all liability from CSULB Environmental Science and Policy Club, and any and/or all liability associated with my participation including, but not limited to personal injury or property damage.

Signature: __________________________________________________ Date: __________

Looking forward to an awesome and fun semester together!

*membership is open to all matriculated students