First Name:
Last Name:
Address:		City:		Zip:
Home Phone:
Email Address:
Grade this fall:

Name of school attended in Spring of 2008:
Name of school attending in Fall of 2008:

Did you participate in last year's Teen Summer Reading Club?	Yes No
Interested in joining Teen Library Club (TLC Advisory Board)?	Yes No
Do you have the Summer Reading Club gamecard? (If no, please download gamecard after submitting this form.)	Yes No