For any questions about this form, please contact us. Your Name * School Phone Home Phone Email School Collection Information Subject * Reading Level Grade Include Fiction Non-fiction Duplicates (Is it okay to gather two of the same book?) Yes No If you would like multiple copies of the same title, please include the title and the number of copies you would like. Title # of copies needed I want to pick up the materials on this date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Additional information or comments Leave this field blank CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Seymour is known as "Home of the _ _ _ _ _ _ _ _ _" ? * Fill in the blank.