Newspapers In Education
Affidavit Form for Teachers 2013-14
First Name: ____________________________ MI: __ Last Name: ________________________ School: _______________________________________________________________________ Mailing Address:___________________________ City: _____________________ Zip: ________ Phone Number: ( )_____ - _______ Ext: _____ Fax: ( ) ____ - ________ Grade(s) Taught: ________________________________________________________________ Subject(s) Taught: _______________________________________________________________
Email: (Required, either yours or a school contact person)____________________________
You may choose to receive The Citizen in print format, digital format orboth. Please check which format you’d like to have delivered to you.£Print Subscription
Please list the total number of papers in which you would like to receive during the2012-2013 school year.
Minimum of 5 for each day signed up for.
Tuesday: _______ Wednesday: _______ Thursday: _______Friday: _______ Saturday: _______ Sunday: _______ Total daily papers received: _______ Total Sunday papers received: _______ Previous customer for 2012-2013 school year?£ Yes £ No Account Number __________
YES! Sign me up for a
this year– receive the newspaper electronically!
New this year, we areoffering teachers a chance to access the electronic version of The Citizen for theirclassroom. Less mess, environmentally friendly, same great content!
£ Please send both thedigital and print subscriptions
to my classroom. (please fillout the print form above)E-Mail Address: (Required for digital subscription) __________________________________________
Please return this form as soon as possible.
School Representative’s Signature ______________________________ Date ____________