Glenn Cooper - Official Website

Book Club Sign-up Form

Share information about your book club to be eligible for an opportunity to have Glenn join your book club meeting by phone or video chat.

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.
	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?
	Member's Home Library Bookstore Church/Synagogue School Community Center Office Restaurant/Coffee Shop Online Other
	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 Glenn with interacting with your group. Type your info here.
Human Check: