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Turning Pages

Turning Pages Book Club Membership Application
*The field marked with () are required fields.**
	Date (mm/dd/yy):
*	Name:
*	Address:
*	City:
	State:
*	Zip Code:
*	Home Phone:
	Email Address:
	Birthday:

	Office Phone:
	Office Fax:
	Office E-mail
*	May we list you in our roster?	Yes No
	Favorite Author(s):
	Favorite Genre:
	Would you consider yourself an avid reader?	Yes No
	How often do you read?
	How many books do you read per wk/mo/yr?
	Have you ever been in a book club?	Yes No
	If so, which one?
	Are you still a member?	Yes No
	If not, why?
	What are you looking for in a book club?
	What will you contribute to a book club?
	Comments:
		Membership Dues for 12 months:$60.00 Due and payable January 1st of each year Make checks payable to: Turning Pages