* Club Coordinator Name (Main Contact)

* Email

* School/Club Name

* Street Address

* Town

* Postal Code

* Phone

* How many students will be participating in the Seventh Generation Club in 2018/2019?

* If you would like to receive student daytimers for the next school year (2018-2019), how many? (limits may apply - especially if your numbers vary greatly from the previous year)

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

* Comments (optional)

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