"Diary of a Broken Mind" Book Club Request
Thank you for your interest in the book, Diary of a Broken Mind: http://diaryofabrokenmind.com. This is where you request a date for an in-person book club meeting or meeting by video (google hangout, zoom, skype)
Email address *
1. First and last name *
Your answer
2. Phone number *
Your answer
3. Approximately how many people in your club/group? *
Your answer
4. What dates might you be looking for? *
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4a. Additional date (there will be an opportunity to enter more dates at the end if necessary)
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5. What time does your club meet? *
Time
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6. Your location? (City, State) *
Your answer
7. If you are not in Richmond, VA, are you OK with using Google hangout, skype or Zoom? (it will be only two-way. Your group together and me)
8. All participants need to have purchased a book and be subscribers. Club members may unsubscribe at any time. You can use this form to leave additional dates or comments.
Your answer
A copy of your responses will be emailed to the address you provided.
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