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Student s Name Address City State Zip Phone Email School Where Enrolled Major GPA Number of Units Enrolled Semester/Quarter Units please circle one Projected Year of Graduation Check one of the following PECG Member PECG Retired Member Dependent If Dependent Name and relationship of PECG member PECG Section 455 Capitol Mall Suite 501 Sacramento CA 95814 Phone 916 446-0400 Fax 916 446-0489 Email pecg pecg. Org www. pecg. org Please list your work/volunteer and/or school involvement...
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