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PSEG Long Island - Safety Sleuth  
Program Registration Form
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What is your role? *
First and Last Name *
Your Title
County *
School District *
School Name
Street Address *
Town, State, Zip *
School Phone and Extension *
Cell Phone
School Affiliated Email Address *
What grade level will you use program? *
How many students are in your class or classes, that will be using this program? *
How would you like your student workbooks?
Clear selection
If Hard copy, how many copies will you need (max of 30 per class)
What is the best way to contact you?
Comments or questions?
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