OrgSync: UCLA Center for Student Programming 1/11/10 12:46 PM

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Individual Authorized Signatory Form

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Individual Authorized Signatory Form

Individual Authorized Signatory Form

Each of the 3 Authorized Signatories must complete this form for registration to be valid

Organization Name *

Enter the Identical Name of Organization that was used for the Campus Registered Organization Form. If
the name you enter is different, your registration will not be entered.

Bruins For Traffic Relief

Last Name *
Join An Org
Please enter your last name.
UCLA Center
for Student
Programming First Name *
Please enter your first name.
Home
People
Calendar
E-mail address *
Tools
Events Use the same email address that you used to register with OrgSync.
News
Forms
Polls
University ID # *
Contact Books
Links Enter your 9 digit UCLA ID number without any punctuation, spaces or dashes (9 digits only). Double
To-do List check to insure your ID number is correct.
Classifieds
Tutoring

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OrgSync: UCLA Center for Student Programming 1/11/10 12:46 PM

Tutoring
Media University Status *
Discussions
Pages Choose your University Status. Remember that Extension Students are not definitionally UCLA Students.
Website
Contact Us UCLA Student

Terms and Conditions *

My
Organizations As a signatory I agree to act as an authorized representative for the organization regarding the activities of
the registered organization, and I understand that notice to any one of the signatories serves as notice to
UCLA the registered organization. I also agree to abide by the UCLA Regulations on Activities, Registered
Campus Organizations and Use of University Properties.(These policies can be found at
Social Activism www.studentactivities.ucla.edu under policies)

bruinsfortraffic I affirm by submitting my name and University ID Number, below, that I assume responsibility for the
planning and implementation of the Organization’s activities. I also affirm that as an Authorized Signatory
Administration for the organization, I will assume responsibility for complying with any contractual obligations created on
behalf of the registered organization.
UCLA Center
for Student I am aware that only full-time UCLA students or University personnel may serve as Authorized
Programming Representatives.

I Agree
Contact Info *

This Section will be automatically filled in for you from your OrgSync data.

First Name: Matthew

Middle Initial:

Last Name: Kroneberger

Email Address: matt4590@ucla.edu

Phone Number:

Address:

City: Los Angeles

State: CA

Zip: 90024

Finish

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