ATTENTION: The Book Group Signup Form is experiencing technical difficulties. To submit your book group to Jessica, please send an email, with the requested information below, to JessicaTilles@aol.com. You will receive a confirmation email shortly after. Please accept our apologies. We hope to have this issue cleared up shortly.

 

Dear Reader,
I love talking to book groups about my books, and forging relationships with people from all over the country. I would love to visit one of your discussion groups in person or by phone.


Book Group Signup Form: Share information about your book club for an opportunity to have me join your book club meeting in person or 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.

 

 

Web site:

 

if your group does not have a web site, type "none" in the space provided.

 

 

 

Number of Women:
Number of Men:

 

approximate or average numbers are fine if your membership is not consistent.

 

 

How old are the members in your group. Please select all that apply

Ages:

Under 25
26-35
36-45
46-55
 56-65
 over 65

 

 

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 Jessica with interacting with your group.

 

 
 



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