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2. 
4. Reader's Name:*
5. Home Library*
   -- Select One --Bent MountainGlenvarHollinsMt. PleasantSouth CountyVinton

   Select the location you'll pick up your prizes.
7. Phone Number:*
8. Email Address:
10. Instructions:
    Please fill out the form below for all levels that you need to pick up prizes for. You can fill this form out each time or pick up all prizes at the completion of the program. For questions give us a call at 540-772-7507.
12. 
13. 50 Books Read Prize: Sticker

    Choose one. If you have already picked up this prize, please leave blank.

    1. Yellow
    2. Blue
    3. Green
    4. Red
15. 
16. 200 Books Prize: Stamper

    Choose one. If you have already picked up this prize, please leave blank.

    1. Animal
    2. Emoji
    3. Letter
18. 
19. 400 Books Prize: Bubble Wand

    Choose one. If you have already picked up this prize, please leave blank.

    1. Red
    2. Purple
    3. Pink
    4. Orange
    5. Green
    6. Yellow
    7. Blue
21. 
22. 600 Books Prize: Shaky Egg

    Choose one. If you have already picked up this prize, please leave blank.

    1. Yellow
    2. Red
    3. Pink
    4. Orange
    5. Blue
    6. Green
    7. Purple
24. 
25. 800 Books Prize: Finger Puppet

    Choose one category. If you have already picked up this prize, please leave blank.

    1. Farm
    2. Pet
    3. Zoo
27. 
28. 1,000 Books Prize: Book

    You did it! You'll also receive a certificate and bag. Please choose one title below.

    1. Vegetables in Underwear
    2. Peek, Otter!
    3. If You Give a Pig a Party
    4. Pete the Cat's Train Trip
    5. Biscuit in the Garden
    6. How Do Dinosaurs Play with Their Friends?
    7. Clifford the Big Red Dog Board Book
30. Thank you!
    We will contact you when your prizes are available for pick-up at your favorite RCPL location. We appreciate your patience!
    Questions? Email kids@roanokecountyva.gov.
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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