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* 1. Club Coordinator Name (Main Contact)

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* 2. Email

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* 3. School/Club Name

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* 4. Street Address

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* 5. Town

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* 6. Postal Code

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* 7. Phone

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

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* 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)

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

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* 11. Comments (optional)

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