* 1. Club Coordinator Name (Main Contact)

* 2. Email

* 3. School/Club Name

* 4. Street Address

* 5. Town

* 6. Postal Code

* 7. Phone

* 8. How many students will be participating in the Seventh Generation Club in 2017/2018?

* 9. If you would like to receive student daytimers for the next school year (2018-2019), how many? (limits may apply - sorry we are out of 2017-2018 daytimers)

* 10. If you would like to receive student newsletters, how many?

* 11. Comments (optional)

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