Readers’ Choice Registration Form 2017-2018

*First Name:
*Last Name:
*School/Library Name:
*Address:
*City:
*State:
*Zip:
*Phone Number:
Fax Number:
*Email Address:
*Grades served:

My school/public library would like to register for: (Check all that apply.)
Monarch (K-3) - $10
Bluestem (3-5) - $10
Abraham Lincoln (9-12) - $10

Payment Options:
If using a Purchase Order or paying with check please mail a copy of the purchase order or the check (payable to ISLMA) to
ISLMA, P.O. Box 1326, Galesburg, IL 61402
Online Credit Card Payment
Purchase Order    PO#
Check

Total Cost: $
*Card Type:
*Name on Card:
*Card Number:
*Expiration Month:
*Expiration Year:
*CCV:

 

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Online Payments

 

 
     
 
Date Modified: 3/17/17

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Illinois School Library Media Association | PO Box 1326 | Galesburg, IL 61402-1326
Telephone: 309-341-1099 | Fax: 309-341-2070 | email
: execsecretary@islma.org
webmaster

ISLMA is not responsible for the content or availability of any Internet sites external to the ISLMA website.