Print this page, fill it out, and return it to room 176 or 321 (only during 6th block though) with payment to reserve
your book.
PLEASE PRINT, CLEARLY!!!
MY LAST NAME:____________________________________________
MY FIRST NAME____________________________________________ MIDDLE NAME:_____________________
I AM A FRESHMAN SOPHOMORE JUNIOR SENIOR HOMEROOM:_____________________________________
PARENTS' FULL NAME(S):______________________________________________________________________
PHONE NUMBER(S):___________________________________________________________________________
CHECK NUMBER:___________________ NAME(S) ON CHECK:________________________________________