Print, Complete, and Mail to
Nocal Environmental Student Network
PMB 217
5150 Fair Oaks Blvd.
Suite 101
Carmichael, California 95608-5758
Name: __________________________________________________________
Telephone: (________) _______- _______________
Street Address: _______________________________________________
City: ________________________________________________________
Zip: __________________________
School: _______________________________________ Grade: ________
Sex: ___________ Age: __________ Birthdate: ______________
E-Mail _____________________________________ Vegetarian: Y N