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Join the Vermont Council on Reading
Membership Form
Name:__________________________________________
Address:________________________________________
City/Town:______________________________________
State & Zip:______________________________________
Home Phone:____________________________________
E-mail Address:__________________________________
Since some of our correspondence will be by e-mail it is vital that we have a current e-mail address.
School:__________________________________________
School Phone:____________________________________
Teaching Assignment:____________________________
Amount enclosed:________________________________
Please mail to:
Jane Nimblett
1012 Green St. Ext
Waltham, Vt. 05491
or:
Rita B. Smith
7123 Vt. Rte 17 W
Addison, Vt. 05491
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