EarthTeam
EarthTeam’s Energy Poster Contest
Student & Teacher Validation Form

Student Information

By signing this form I verify that I have completed the EarthTeam Best Poster/Poster Blitz Contest.

Student Name (Print)_________________________________________________________

Age______________________________________________________________________

Student Signature__________________________________________Date_____________

Student Address_________________________________City______________Zip________

Student E-mail______________________________________________________________

Phone____________________________________________________________________

School Name_______________________________________________________________

School County______________________________________________________________

School Address__________________________________City _____________Zip________

Teacher/Adult Supervisor Information

I verify that the student named below has completed the EarthTeam Best Poster/Poster Blitz Contest.

Teacher/Adult Supervisor Name________________________________________________

Teacher/Adult Supervisor Signature____________________________Date_____________

Teacher/Adult Supervisor E-mail_______________________________Phone____________

Return to:
EarthTeam Student Validation
PO Box 4686
Walnut Creek, CA 94956
Fax: (925) 376-1456