FOR PROFESSIONAL USE ONLY

ANNUAL MEMBERSHIP SERVICE REQUISITION

SCHOOL SYSTEM INFORMATION:

Name:__________________________________________

Title:___________________________________________

School System:___________________________________

Address:________________________________________

City:_____________________ State:_____ Zip:________

Email:_________________________________________

TO ORDER CHECK ONE:
All payments must be in U.S. funds, drawn on a U.S. bank.

P.O. Number________________

Payment enclosed (Payable to SchoolMatch)

Charge my: MC__Visa__AmEx__Discover__

Card No._____-_____-_____-_____Exp. Date______

Signature_____________________________________

Tel: (____)______-_________

Fax: (____)______-_________

Service Number:
WPW2001

Please mail to: SchoolMatch
6167 Deeside Drive, Dublin, Ohio 43017
or Fax to: (614) 764-4709

Annual SchoolMatch Membership

Services if purchased
separately

Preferred Member
Package

Services include:

• Membership Plaque

• "Mean Match": Receive a list of the 10 school systems
  most demographically similar to member school system

• Report Card: Copy of the report of your school system
  available to the public on http://schoolmatch.com

• Library of SchoolMatch commentary on CD-ROM

SCHOOL SYSTEM PREFERRED ANNUAL MEMBERSHIP

A $1252 VALUE

$98


$995


$49


$110

Included


Included


Included


Included


$395