Sign up for the Wellness Sisters Book Club
1. General Information
Name
*
First Name
Last Name
Address
*
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
E-mail
*
example@example.com
Cell Phone Number
*
Which Wellness Sisters programming are you interested in? (Check all that apply.)
*
Book club
Walking group
Integrative Health Workshops
How would you like to be contacted? (check all that apply)
*
Email
Text
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2. Book Club Information
What genre of book/media would you most like to read?
*
Historical Fiction
Historical Non-Fiction
Romance
Self Help (Financial Freedom, Wellness, etc.)
Mystery
Fantasy
Science
Podcasts
Articles
Other
What day(s) work best for you?
*
Monday evenings
Tuesday evenings
Wednesday evenings
Thursday evenings
Friday evenings
Saturday mornings
Saturday evenings
Sunday mornings
Sunday evenings
None of the above times work for me
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3. Demographic Questions
The following optional and confidential question(s) help us understand who we serve and how we can support you. Please find the options that are the best fit for you or please self-describe.
Age: What is your age?
17 years old or younger
18-24 years old
25-34 years old
35-44 years old
45-54 years old
55-64 years old
65-74 years old
75 years old or older
Gender: How do you identify?
Woman
Man
Non-binary
Prefer to self-describe
If you chose "prefer to self-describe," please do so here.
Race/Ethnicity: How do you identify?
Asian or Asian American
Black or African Descent
Hispanic or Latino/a/x
Middle Eastern or North African
Native American or Alaska Native Native Hawaiian or other Pacific Islander
White
Another race or ethnicity, please describe below
If you chose "Another race or ethnicity," please describe here.
Do you work in any of the following categories/industries:
I'm currently a student
Academia (professor, etc.)
Biotech/IT/Business/Sales
Environmental
Government
Healthcare
Non-profit
Philanthropy
Retail
Research or Policy Institute
Service/Hospitality
Transportation
Other
If you chose other, please describe
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