Expo Neighbors Environmental Group

EXPO RANGER APPLICATION FORM

Use this form for Adults and Minors

Instructions: Print out this form. Complete the form by either typing or printing neatly. Mail the completed application form to:
Expo Neighbors Environmental Group
Expo Rangers Coordinator
4123 Exposition Blvd
Los Angeles, CA 90016

Date of Application:

Name:

Address:

City:

State:

Zip Code:

Phone:

E-mail:

Birth date:

Age:

If over 25: Driver’s License # and issuing State:

Expiration date of Driver’s license:

Gender:

Grade (if in school):

School name:

School Address:

Citizenship:

If not a US citizen, passport #, and expiration date:

If not a US citizen, visa type, #, and expiration date:

If not a US citizen, Employment Authorization Document #:

List any Environmental or Science Courses you have taken (Use an extra sheet of paper if needed.)

List any Environmental Organization Memberships you hold.

List any Special Awards or Recognition you received or trips you have taken:

Indicate if you have had any of the following special training. If yes, please list the expiration date for any of the following:

First Aid No Yes Expiration date:

CPR No Yes Expiration date:

Water Safety No Yes Expiration date:

Other Special Training (please list):



Briefly State Why You Want to Join the Expo Rangers (specifically how do you expect to benefit and what can you contribute. Use a separate sheet of paper if needed.):


Signature:

Print your name:

Date:

If under 18 years old, Parent/Guardian signature required.

Print name of Parent/Guardian

Date: