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Senior Project® Network Subscription Form

Complete and Submit
To become a full member of the Senior Project® Network™, complete the form below. You may arrange for payment of the applicable fee by school purchase order, direct billing, personal, or school check. NOTE: Information with asterisk * is required.

A. Membership Options and Fees*

Choose Type of Membership*

	First Time New Membership
	Renewal Membership

Individual Membership - $49 per yr.

Four (4) or more staff from same high school - $43 each per yr.

B. Senior Project Network™ Members

Primary Contact Name (first, last)*

Primary Contact Email*

1. Name (first, last)

2. Name (first, last)

3. Name (first,last)

4. Name (first, last)

5. Name (first, last)

6. Name (first, last)

Note: if this form doesn't accommodate your subscription needs, please call the office at 541-770-9483

C. School Information

High School District or Cooperative*

High School Name*

High School City/State*

D. Billing Address

Contact Name (first, last)*

Contact Email*

Address*

City, State*

Zip Code (+4 Zip accepted)*

Phone*

Fax*

E. Method of Payment

Choose method of payment*

Check or PO Number

F. Senior Project® Implementation Information

SP Coordinator Name (first, last)*

SP Coordinator Email*

Number of yrs. SP implemented*

Number of SP students this year*

NOTE: Members will receive periodic updates and information about Senior Project® by email, within the limits of our Personally Identifiable Information (PII)policy. All prices are in US dollars.

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Senior Project® Network Subscription Form