1.	Contact Information: *
	First Name:   Last Name:   Street Address:   City:   State:   Zip Code:

2.	Please check one of the following options that best describes yourself:*
	Student attending a BOCES Program Parent of a student that attends a BOCES Program Sullivan County Resident Local District Employee Business Owner Resident of another County

3.	What type of information would you like to receive?*
	Newsletters   News Releases   Program Updates   Course Offerings   New Program Notifications   Student Success Stories Type of Publication:

4.	How would you like to receive the information:
	Yes   No   Both Electronic Copy:       Hard Copy: (only available for newsletters and publications)

5.	Would you like to receive phone messages regarding school closings and reminders?*
	YesNo

6.	Since you indicated that you would like to receive school closing messages and notices please complete the following information.
	Primary   Secondary Home Phone Number(s):     Cell Phone Number(s):     E-mail Address(s):

7.	What other information would you like to BOCES to provide?