ENTRY FORM - Disney

ENTRY FORM
Please print: If the above information is incorrect, please mark changes.
Teacher’s Name:
School principal’s Name:
Number of Students in Class:
Teacher’s Email Address:
Principal’s Email Address:
School Phone Number:
(Maximum of 50 students – one class per form)
School County:
If “Year-Round,” State “Off-Track” Months:
Our class would like to participate in:
(check one) Environmentality Pledge Only
Environmentality Pledge plus Class Project
Please refer to the Environmental Education Resources in the brochure. Choose up to five pamphlets from the listing and locate the
number to the left of each. Circle the matching number below that corresponds to each requested pamphlet.
1 2 3 4 5 6 7 8 9 10 11 12 13
Return this postage-paid Entry Form (see reverse) by mail or fax to 407-855-8807.
DUE DATE: Postmarked or faxed on or before November 18, 2005.
For questions regarding Jiminy Cricket’s Environmentality Challenge refer to the
instructions in the brochure or call toll free 1-888-JIMINYC (1-888-546-4692).
By entering or being entered in Jiminy Cricket’s Environmentality Challenge, schools, students, teachers, and adult chaperones from the winning classes are consenting to the use of their
names and likenesses for marketing and advertising purposes without additional compensation. The class project, including any support documents, will become the property of The State
of Florida and will not be returned.

Complete form, fold here, seal with tape and return in mail.
BUSINESS REPLY MAIL
FIRST CLASS MAIL PERMIT NO. 5035 ORLANDO, FL
POSTAGE WILL BE PAID BY ADDRESSEE
NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES
FULFILLMENT SERVICES
JIMINY CRICKET’S
ENVIRONMENTALITY CHALLENGE
PO BOX 621081
ORLANDO, FL 32862-9080
Complete form, fold here, seal with tape and return in mail.