The Long Shadow DVD Request Form – Illinois Education Association

Convener of Event
Regional Office/District/Local*
Convener Name*
Any of the following: IEA Regional Chair, IEA Local President, IEA UniServ Director
Convener Email*
DVD Request
Please list the screening details*
Audience / Location / Date / Time
When can you return the DVD?*
Please pick a date you will mail the DVD back.
MM slash DD slash YYYY
Mailing Address for DVD*
Name Street Address City State ZIP Code
DVD Terms of Use
IEA has received permission to distribute limited copies of The Long Shadow for use in Illinois school districts and aligned organizations. To show a copy of The Long Shadow users must abide by these terms. By clicking below you agree to the following terms. If you have any questions about these terms, please contact Denise Ward at denise.ward@ieanea.org or 217-544-0706.
The Long Shadow

Terms of Use of DVD’s provided by the Illinois Education Association (IEA)
1. All viewers must sign in and provide the following:
  1. Name
  2. Email address
  3. Whether they are an IEA member
2. Return the DVD and sign in sheet to Denise Ward within 2 business days of the screening.
Agreement*
- I agree to the terms of use

Summer Leadership Academy