Submit reading record

Adult leaders and parents fill out these forms or help children fill them out. Ellen Miller is the coordinator for the east region of Central Plains and Joan Friesen is the coordinator for the west region. Fill out the form for your region. Your form will be sent directly to your regional coordinator and she will mail you the gift books. Questions? Contact Ellen at [email protected] and Joan at [email protected].

Note: Though we encourage children and adults to read many Shalom Readers Books, rewards are limited to 1 per reader.

Reading record for readers in Iowa, Illinois, Minnesota or Wisconsin

* Indicates required field

Name *

First

Last

Age *

Address (for adults, the address of person or church library I'd like my free book shipped to) *

Line 1

Line 2

City

State

Zip Code

Country

Church name *

Titles and authors of the seven books I've read *

For Children, titles of the two books for which I did a creative response; for Adults, titles of three books with which I engaged more deeply. *

Title and author of the book I have chosen from the Shalom Readers (children or adult) list as my free gift: *

Submit

Reading record for readers in Nebraska, Colorado, South Dakota and Montana