Kids for Saving Earth Request Form

Membership and Product Order Form

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Contact Information
(Please fill in all fields. We will email you to confirm that you have requested this order and that your address is correct. Thank you!)

First Name*
Last Name*
Email*
Address*
City*
State / Province*
Country
Zip / Postal Code*
Phone
Fax

*REQUIRED

KSE Free and Paid Membership Form
The main difference between a free and paid membership is a paid membership receives beautiful, full-colored membership certificates and either an Action Guide (Grade 1-12, 48 pg.) or a Little Kids Guide (Grades PreK-KDG).

I would like to join as a: (type in number of memberships)

Free KSE Network Member
Kid ($10, includes All About KSE DVD, 1 Certificate, 1 Guide book)
Family ($15, includes All About KSE DVD, Several Certificates, 1 Guidebook, Healthy Home Book, other educational materials)
Group ($16, includes All About KSE DVD, 30 Certificates, 1 Guidebook, Healthy Home Book, other educational materials)

I am a/an:
Instructor
Student
Student-Teacher
Other

School/Group Name:
Number of Students:
Ages to

How did you hear about KSE?

I would like to receive KSE E-Pal News for Instructors.
I would like to receive KSE E-Pal News for Kids.
I would like to receive an email about providing my school/group with a free web page on the KSE site.

KSE Products Order Form
Product Description	Price	Shipping	Quantity
Year-round "It's a Gift" notecards:
12 blank notecards with envelopes	$6.00 per 12	$1.50
12 notecards with verse & envelopes ("May Peace and Health Be With You Throughout All of Earth's Seasons!")	$6.00 per 12	$1.50
"It's a Gift" Poster	$5.00 each	$2.00
KSE Buttons	$1.50 each	$0.83
KSE Pins	$4.00 each	$1.00
KSE Bags	$6.00 each	$1.50 each
"Travel the Earth" Books (for families and classrooms)	1-3 $4.00 each 4-10 $3.00 each 11 + $2.00 each	$1 $2 Call for rate: $
"We're Not Asking for the Moon"	1-3 $4.00 each 4-10 $3.00 each 11 + $2.00 each	$1 $2 Call for rate: $
Earthworks Central	$20.00 each	$6.00
T-Shirts (only small and XL left)	$6.00 each	$1.50 each	S XL
Little Kids' Guide	$3.00 each	$1.00
Action Guide	$3.00 each	$1.00
KSE Promise Certificate Poster	$4.00 each	$2.00

Check Here if International Shipping is needed ($5 extra)
Check Here if a MN Resident (6.5% Sales Tax)

Click here to order Soda Club Merchandise to support Kids for Saving Earth!

Credit Card Information
(if signing up as a paying member or ordering products)

In order to save funding we utilize the charging services of our sponsor, NATURAL SPACES DOMES. This is what you will see on your credit card. All KSE charges are transferred to KSE.

Credit Card Type:

Visa
Mastercard

Credit/Debit Card Number - - -

Expiration Date

Other Information
(optional)

Yes, I would like a Spanish translation of educational materials when available.
Yes, I would like to receive the School Pesticide Monitor from Beyond Pesticides.
The environment may be making kids sick! I would like to receive information about Children's Environmental Health Issues from CHEC.

We have been active in the following projects sometime in the last year: (Check all that apply)
Reading the KSE News Recycling Composting Tree planting/forest preservation Energy Saving Protecting Endangered Species Writing Letters To Leaders Pollution Prevention Drawing and Displaying posters Writing articles Contacting media Staging special events Fundraising Activities	Tell us about your environmental concerns and activities!

Do you know a special young Defender of the Planet™? KSE would like to honor kids who are especially dedicated and actively involved in Earth-saving activities. We would like to invite them to become members of the KSE Kids Advisory Board. Please tell us about a KSE Kid who has courageously gone above and beyond the call of duty and would like to tell the world about it. Have the student write about 100 words describing his/her Earth activities, add your comments, and forward to KSE.

Kids for Saving Earth
PO Box 421118
Plymouth, MN 55442

Email Us at KSEWW@aol.com

Please look over this form one more time to make sure you have accurately filled out all required information to insure that your request is processed quickly and accurately. Thank you!