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Club & SIGs Registration &
Allocation Request
2018 - 2019

General Information

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* 1. Club/SIG Name

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* 2. I am authorized to submit the registration and allocation request on behalf of my HLSA Club/SIG

Name

Email Address

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* 3. Current Club/SIG President, Chair, Co-chair Info:

Name:

Email Address:

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* 4. President/Chair's Term Start Date

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* 5. President/Chair's Term End Date

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* 6. Please rate the level of alumni engagement and activity of your Club/SIG.

Dormant/Inactive

Poor

Moderate

Great

Newly Formed Club/SIG (as of July 1, 2018)

Revitalized Club/SIG (as of July 1, 2018)

Dormant/Inactive

Poor

Moderate

Great

Newly Formed Club/SIG (as of July 1, 2018)

Revitalized Club/SIG (as of July 1, 2018)

Comment

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* 7. What are your Club/SIG's key goals for the upcoming year?