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Submit this form when you have completed the program.

Information must be completed and returned by April 5, 2013

All personal information submitted will be held confidential and not used for any purpose other than the requirements of the Reading is an Investment program (mailing information to complete the reading program and entrance into the college savings account drawings).

*All Fields Required

* indicates a required field

First Name *

Last Name *

Entry Number *

Address *

City *

State *

Zip *

Phone Number *

School *

Grade *

Parent or Guardian Name *