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* Club Coordinator Name (Main Contact)

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* Email

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* School/Club Name

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* Street Address

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* Town

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* Postal Code

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* Phone

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

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* 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)

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

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* Comments (optional)

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