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* 1. Please enter your name.

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* 2. Please enter the email you would like us to contact you with book club updates.

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* 3. Please let us know which apply to you.

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* 4. Please select the book you would like to read this month.

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* 5. Please identify all days that work for you.

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* 6. Please tell us the time/s that work for you.

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