Read On Wisconsin! - Register!

Read On Wisconsin

ADULT REGISTRATION!

STUDENT REGISTRATION!

	Salutation/Prefix:
	First Name:
	Last Name:
	School/Library/Facility:
	Work Address Line 1:
	Work Address Line 2:
	Work City:
	Work State:
	Work Zip Code:
	Email Address:
	Book Club Level: Preschool (Ages 0-4) Primary (Grades K-2) Intermediate (Grades 3-5) Middle School (Grades 6-8) High School (Grades 9-12)
	Age/Grade of Students:
	Number of Students:
	Contact Type: Contact me about Reading Days at the Residence. Contact me about First Lady Jessica Doyle visiting my school/library/facility!
	How did you hear about the Book Club?:
	Verification Text (required): Enter the red text below into the adjacent form field then press "Register".
	Please only click on the REGISTER button once. It may take a few moments for your form to be processed. Thank you!

	First Name:
	Last Name:
	Teacher's Name:
	School:
	School City:
	Grade:
	Teacher's Email Address:
	Book Club Level:
	How did you hear about the Book Club?:
	Verification Text (required): Enter the red text below into the adjacent form field then press "Register".
	Please only click on the REGISTER button once. It may take a few moments for your form to be processed. Thank you!

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Wisconsin First Lady Jessica Doyle Executive Residence 99 Cambridge Road Madison, WI 53707