Kordica

Subscription Service Registration

Phone

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Contract Start Date

Prorated Subscription Fee

Prorated Consulting Hours @ 2 hrs/mo

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Prorated Months

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Subscription Period End Date

School/District Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Website(Required)

Administrator Name(Required)

First Last

Title/Position(Required)

Administrator Email(Required)

Phone(Required)