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Your Name

Your Title

Department

College/university

Street address

City, state, and zip code

Your Email

Office phone

Is this decision individual or committee?

 Individual Committee

Other members of this committee who should receive a copy of this book

Title of course

Number of students

Number of sections

Adoption decision date

Likelihood of change

 Excellent Good Fair Not likely

College/university bookstore/textbook buyer’s name

Phone number

Date

Upon receipt of the complimentary copy, I agree to review your book and consider it for adoption. If I adopt the book I will contact my bookstore and request that it order the book in sufficient quantity for my class. If this book is positively reviewed but not adopted, I agree to recommend it to my students for bookstore and/or library purchase.

 yes no

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