Sustainable Crew Registration Form

Fill out form only AFTER you attend your first Sustainable Crew meeting and you have a "Magic Number".  All boxes require input, so please leave nothing blank.

In order to participate in a Sustainable Crew you must provide your contact information, course and professor information for the class in which you are receiving extra credit, and demographic information.

Each box must be filled out in order to submit this form. You are not registered in a Sustainable Crew until you have submitted this form.

If you have questions or are uncertain about any of the requested information, please contact us at 310.458.8716 x1.
 

Contact Info:  
First Name:
Last Name:
Student ID Number (If you do not have a student id number type N/A)
Home Phone: (Example 310.458.8716)
Mobile Phone: (Example same as above. If you don't have a mobile phone type N/A)
E-Mail:
Street Address:
City: (No abbreviations please)
State:
Zip Code:
Student?
Affiliation:
   

Crew Number:

 (Your Crew Leader provides this number)
   
Participation status  
Student
Santa Monica Resident  
   
Extra Credit Course Info:  
Please select NO EXTRA CREDIT and N/A if you are not a student or are not receiving credit.
Professor 1:
Course Meeting Day 1:
Course Start Time 1: (Example 9:30am or 12:45pm. Type N/A  if not getting credit)
Professor 2:
Course Meeting Day 2:
Course Start Time 2: (Example 9:30am or 12:45pm)
Semester
Year
   
Demographic Info:  
Gender:
Age:
Ethnicity:
Income: