subject_line
First Name (person in charge of book club)
*
Last Name (person in charge of book club)
*
Program
*
EOC
McNair
Student Support Services
Talent Search
Upward Bound
Upward Bound Math/Science
Veterans Upward Bound
Other
Other
Title (of person in charge of book club)
*
Institution
*
Email Address (of person in charge of book club)
*
Work or Cell Phone Number:
*
Type of Phone Number
*
Work
Cell
This number is both my work number and my cell phone number
Director First Name (if different than above)
Director Last Name (if different than above)
Email Address (if different from above)
Work or Cell Phone Number (if different from above):
Type of Phone Number (if different from above)
Work
Cell
This number is both my work number and my cell phone number
Potential number of students in the Book Club [Suggested minimum number = 10]
*
Less than 10
More than 10 but less than 20
More than 20 but less than 40
40 or more
Which book are you using for this club?
*
Across That Bridge
March (trilogy)
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