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Your Name:* 

Teacher/Educator: 

Parent/Community Member: 

Student: 

School, Club or Organization: 

Grade Level of Students/Youth:

Your Grade Level (If a Student): 

Address:

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How did you learn about Global Care?:

I am interested in the following:

• Receiving E-Updates (E-mail needed): 
• Supporting a current Global Care service initiative: 
• Starting My Own Global Citizenship Community: 
• Joining the Youth Coalition: 
• Volunteering: 
• Joining an Adult Group in support of a Global Care Chapter:
• Donating funds:  
• More Information (Specify): 
  
  

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