The Environmental Forum of Marin Application Form

		The Environmental Forum of Marin PO Box 150459 San Rafael, CA 94915-0459 Telephone: 415-479-7814 www.marinefm.org
You may print this page and fill it out by hand, or enter the information below and then print and sign it.

Last Name

First Name

Address
City/St/Zip

Phone #

E-mail,
Fax#

1. How did you learn of the Sustainable Earth Forum?

2. What do you hope to gain from the Sustainable Earth Forum?

3. Do you presently belong to any community organizations?

4. Do you presently read any environmental publications?

5. Do you have any special physical requirements?

6. Occupation/profession

*	It is the policy of the Environmental Forum of Marin that completion of the Sustainable Earth Forum is required for membership. Requirements for graduation include no more than three (3) absences, the completion of a 2-minute advocacy speech and presentation of a student project.
*	I agree to attend all 18 Tuesday sessions from 9/9/2008 to 2/3/2009 from 8:30 a.m. to 3:30.p.m. Field trips may run longer. No classes will be held for three sessions during Thanksgiving week and the winter holidays (November 25, December 23, and December 30).
*	Enclosed is the completed and signed Medical Release form.
*	Enclosed is a $50 check for the deposit. I will pay the balance on or before 8/9/2008. Registration fees are are $350 for those who register by August 1 and $380 for those who register after August 1.

Signature:_______________________________________ Date:________________________

(Last Update 5/7/2008)