CODE: EDU101 REV. 07/09MECHANICAL SIZE:

102049 B&N 102049.BN.Solo Application.V2R307/01/09 Ed. Appreciation App 8.375" x 10.875" 8.625" x 111.125"

TBD 150 30%

MECHANICAL 2 3

EDU101 Rev. 07/09

FIRST NAME LAST NAME

HOME ADDRESS APT./SUITE

CITY STATE ZIP COUNTRY

PHONE Your phone number can be used in place of your Educator Card if you have lost your card.

SCHOOL NAME

SCHOOL DISTRICT

SCHOOL ADDRESS

CITY STATE ZIP

SCHOOL EMAIL ADDRESS

Educator ProgramApplication

Barnes &Noble

To receive your free Barnes & Noble Educator Card, complete this application and present it to a Bookselleralong with valid proof of employment and photo ID (substitute, student, and retired teachers not eligible).

2. School Information (required)

1. Personal Information (required)

BOOKSELLER: Aff ix Educator number sticker here

EDU101 Rev. 07/09

HOME EMAIL ADDRESS

Please ensure that your home email address is valid and able to receive promotional offers. A web-based email address such as Yahoo! Mail, Hotmail, Gmail, AOL, etc. is recommended.

INTERESTS: If you would like to receive more information on any of the following, please check the box next to it and someone will contact you.

(CHECK ALL THAT APPLY) Bookfairs Discount Purchasing Program for Schools Special Events for Educators Field Trips / Store Tours

Required Reading Bulk Gift Card Purchases / Discounts General Store Events

YOUR TITLE (CHECK ONE) Teacher District Employee Special Ed / ELA School Administration / Supervisor Media Specialist / Librarian

Principal Guidance Counselor Home Schooler Other

GRADE LEVEL (CHECK ONE) Pre-school Elementary School Middle School High School K-12 School

SCHOOL TYPE (CHECK ONE) Public Private Home School Charter School

Barnes & Noble Educator discounts are valid on eligible purchases at Barnes & Noble stores, and online at www.bn.com. Discounts do not apply to the following: Café items; music; DVDs and Blu-ray Discs; periodicals; textbooks; the purchase or renewal of a Barnes & Noble Membership; gift-wrapping; the purchase of a Barnes & Noble Gift Card; gift certificates; digital content (including but not limited to digital books, magazines and periodicals); certain digital devices; audiobooks in MP3 or any other format; shipping or handling expenses; or any products provided via BookQuest (e.g. used books, PC and video games, etc.). Educator discounts are not available at Barnes & Noble College Bookstores. Barnes & Noble Educator Program Terms and Conditions are subject to change without notice or liability. You may view the current Terms and Conditions at www.bn.com/educator or you may obtain a copy at a Barnes & Noble store. You may view the current version of the Barnes & Noble Privacy Policy online at www.bn.com.