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Teachers Collection Request Form
Teacher's Name:
School:
Teacher's (Corporate/Group) Library Card #:
Phone Number:
E-mail address:
(optional)
Topics:
Target Age:
(Grade etc.)
Number of Books Needed:
(30 Maximum)
I would like:
Fiction
Non-fiction
Both
Individual Titles:
Please include (if available):
Please select one
CDs
DVDs
VHS
None
Date Collection is Needed (We are unable to fulfill requests sooner than three weeks from today):
Pick-up Site:
(Branch Location)
Pick Location from List
Bon Air
Crescent Hill
Fairdale
Fern Creek
Highlands/Shelby Park
Iroquois
Jeffersontown
Main Children's
Middletown
Newburg
Okolona
Portland
St. Matthews
Shawnee
Shively
Southwest
Western
Westport
,
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Last Updated: 01/23/2008
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