Registration Form

Hello, We are glad that you chose to start a recycling fundraiser. To get started just fill out this form and your fundraising representative will contact you with in 48 hours.

Thank you

What is the name of your school/organization? *

Address

Street Address

Address continued

City

State *

Zip

How many students are attending this school?

This question is for schools only. If you are an organization you don't have to answer this question.

If you were referred, who referred you?

Full Name: *

If you were not referred, just leave this blank.

Email Address of referrer:

If you were not referred, just leave this blank.

Now for this next step we just need the contact information of the person who will be in charge of the recycling program. We need the name of the person who is in charge, a phone number or an email address so we can contact this person.

Full Name:

Phone #:

()

Email Address

Have you ever participated in a cellphone and electronics fund raiser?YESNO