2021 ALW Reader Registration

2021 ALW Reader Registration

One Reader/Multiple Schools
Please use this form to register yourself or a group for our 4th Annual Ag Literacy Week program during the week of March 15-19, 2021.

Please be sure you have an email for each classroom teacher that you plan to visit as we will be sending lesson and resources to go along with the book to them by email this year.
1. Reader Information
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number (xxx-xxxx)
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
County *
Organization Name
Total # of Classrooms *
Number of classrooms you will be visiting and reading to during Ag Literacy Week
Have you participated in ALW before? *

Yes, and I am looking forward to participating again this year No, but I want to participate this year

2. Participation Information
At least a month prior to Ag Literacy Week, I will make arrangements with the teacher(s) for my visit(s), and coordinate with each teacher the specific day and time for a visit to their classroom to read during the 4th Annual PA Ag Literacy Week, March 16-20, 2020.
Do you agree? *

I Agree

4. Classroom Information
PLEASE NOTE: Most of our Ag Literacy Week educational information will be emailed directly to the classroom teacher this year. We must receive your classroom information no later than January 15th so that they can have it in time for the event.

To assist us in properly preparing your packet of materials for your visit, as well as allowing us to provide the classroom teacher with additional educational materials related to agriculture, we ask that you provide the following information for each Kindergarten-2nd grade classroom you intend to visit:
Do you already have a class in mind for the project? *

Yes, and I have the classroom information to submit below Yes, and I have more than 10 classrooms. Yes, but I am working on getting the necessary information

This form does not accommodate more than 10 submissions at a time, so to avoid having you complete multiple online registrations, we will email you a form to complete with your classrooms’ information.

Please continue to the Payment Information Page.

5. Payment
I understand that there is a $10 donation fee per classroom to cover the cost of the book, which will be given to the classroom teacher following my Ag Literacy Week Visit.
Do you agree to pay the $10 per classroom fee to cover the book cost ? *

I Agree
I would like to pay by: *

Credit Card Invoice

Payment for my books *

Books $ 10.00

Number of Classrooms

I would like to help with the credit card processing fee of 30 cents per book (optional). $ 0.30

Number of Books

Total $ 0.00

Review & Submit
Please use the "REVIEW" button to review all of your Ag Literacy Registration, then press submit to complete your registration.
Should be Empty:

Invoice Payment Information