EEPSA Local Chapter Leadership Participant Information

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Name*
First Last
Email*
School District Number:*
Current role with your EEPSA Local Chapter (if any):
Dietary Requirements (if any)

Please note that our menu is 100% vegetarian and 100% delicious!
Mobility Requirements (if any)
Do you permit us to use photos taken at the Leadership Clinic that may include your image to promote environmental education for EEPSA & CBEEN?*
Anything else we should know?
Photo of you outside*
Max. file size: 32 MB.