You are on page 1of 2

CWU JEDI

Membership Form
2009-2010
Central Washington University

Name: ____________________________________ Email:


____________________________

Year: Fr So Jr Sr Major: ___________________________

Address:
__________________________________________________________________
______

City: _________________________ State: __________ Area Code:


_____________________
Phone (Optional): _______________________________
Note: This information will only be used to contact you regarding club
events, programs, etc. Only club officers will have permission to view this
information.

Member Applicant’s Signature:


_________________________________________________

CWU Jedi President’s Signature:


_______________________________________________

CWU Jedi Secretary’s Signature:


_______________________________________________
709 E. 11th Ave.
Ellensburg, WA 98926
FosterRa@cwu.edu
253-376-1057
*For more information regarding membership, contact the current club president or
secretary. This form will be kept on file for administrative purposes. May the force be with
you, or something to that effect.

709 E. 11th Ave.


Ellensburg, WA 98926
FosterRa@cwu.edu
253-376-1057