Kentucky group discount for DreamBox
2009 - 2010

Teacher Name:

 

Teacher Email:

 

School Name:

 

School District:

 

How many student accounts would you like to purchase for the 2009/2010 school year at a discounted rate of $30 per student?

 
Are you certain that you will have sufficient funding for this purchase?

definitely
 fairly
unsure
Do you plan to pay by purchase order
 check
 credit card

Billing Contact Name:

 

Billing Institution Name:

 

Billing Address (Number, Street):

 

Billing Address (City):

 

Billing Address (State):

 

Billing Address (Zip):

 

Billing Contact Email:

 

Comments:

 If you have any questions regarding this event, please contact the KCM