Sierra Student Coalition

Register for Virginia Sprog '09

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Basic Info

First Name:

Last Name:

Mobile Phone:

Alternate Phone:

I'd like to receive text message alerts from the Sierra Student Coalition.

Nickname:

E-mail (personal):

E-mail (school):

Date of Birth:
Please use the calendar icon to choose your birthday. if you enter it by hand, please be sure to use the format mm/dd/yyyy with leading zeros if necessary.

Gender:

Are you a paid Sierra Club member?

Member #:

Mailing Address

Address:		City:
State:		Zip:

School

Student Type:		Graduation Year
School:
Group:

Event Registration Info

Diet restrictions (vegetarian, vegan, allergies, etc.)?
I need a ride I can give a ride
How did you hear about this event?

Event Essay Questions

Please compose your answers in a word processor and save them on your computer locally then copy and paste them here. This way you won't lose them if something goes wrong with your submission.

Why are you interested in attending this program and what do you hope to gain from the week?
Describe your previous experience. (If applicable) what issues and/or campaigns have you worked on or are you interested in working on?
What skills, energy, or creativity will you be bringing to the program?
What other trainings have you participated in before (non-required)?

Have you registered at www.ssc.org before?

If you have registered as an activist in the past or suspect for any reason you might already be in our database, please click the following button to enter your e-mail address in order to receive a password. This will allow us to use your existing contact information (and allow you to update).