Book Group Signup Form: Share information about your book club for an opportunity to have Susan join your book club meeting by phone!

Group Name:
Contact Name  
First:
Last:
Address:
  (include apt/room/suite #)
City: State:
Zip Code:
Country:
   
Phone:
Email:
  type your complete email address:
ex. your_name@aol.com, or name@yourdomain.com
an invalid email address may cause your submission to be lost.
   
Website:
  if your group does not have a website, type "none" in the space provided.
   
Approximate number of book group members:
   
   
How long has your group been meeting?
  Less than 1 year
1-5 years
5-10 years
More than 10 years
   
Where do you meet?
 
  Please specify "Other"
 
   
How often do you meet? Please select all that apply
Weekly
Biweekly
Monthly
Bimonthly
 		Seasonally
Excluding summer months
Excluding December
Other
  Please specify "Other"
 
   
Please share any other information about your group that can assist Susan with interacting with your group.