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Principals' Clubhouse Registration Form
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* Indicates required question
Email
*
Your email
School Name
*
Your answer
Principal Name
*
Your answer
Principal Email
*
Your answer
Principal Phone
*
Your answer
School Grade Levels:
*
Pre-K
K-2
3-5
6-8
K-8
Please supply your summer shipping address. Books will ship in mid-July.
*
Your answer
Please list the additional two members from your school who will included in your membership to the clubhouse. Educator #1 Name:
*
Your answer
Educator # 1 email address:
*
Your answer
Educator # 1 Position:
*
Choose
Librarian/Media Specialist
Reading Specialist / Literacy Coach
Classroom Teacher
Title 1/ Family Engagement Specialist
Other:
Educator #1 Grade Level(s) (check all that apply):
*
Pre-K
K-2
3-5
6-8
K-8
Required
Please identify the second staff member who will participate in the Clubhouse. Educator #2 name:
*
Your answer
Educator #2 email address:
*
Your answer
Educator #2 Position:
*
Choose
Librarian/Media Specialist
Reading Specialist / Literacy Coach
Classroom Teachers
Title 1 / Family Engagement Specialist
Other
Educator #2 Grade Level (s) (check all that apply):
*
Pre-K
K-2
3-5
6-8
K-8
Required
School Email for Invoice
*
Your answer
How did you hear about the Principals' Clubhouse?
*
Your answer
Please note, submission of this form constitutes an order. You will receive an invoice within 72 hours. Books cannot be shipped until we receive acknowledgment of invoice, PO, or payment.
Sales Representative Name (if applicable)
Your answer
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