Clone of Daughters of Lineage Group

Full Name*

First NameLast Name

Preferred Name (if different):

E-mail*

example@example.com

Phone Number*

Are you 18 years or older?*

YesNo

Do you identify as a Black woman or a woman of color?*

YesNoI Prefer Not To Say

What’s drawing you to the Daughters of Lineages Book Club?*

What types of readings are you most interested in? (Select all that apply)*

Are you interested in a weekly book club?*

YesNoI Prefer Not To Say

What days/times tend to work best for you?*

Weekday eveningsWeekendsFlexible

The book club is expected to be $25 per session or $75 monthly. Does this feel accessible for you?*

YesPossiblyNo / Would like to discuss

Is there anything you’d like the facilitator to know as this space is being shaped?

I understand that this is a community-based book club and not a therapy group.*

I agree

I understand that joining the waitlist does not guarantee a spot and that space may be limited.*

I agree

Would you like to receive updates about future book selections or related offerings?*

YesNo

How did you hear about us?*

If other, please specify.

Daughters of Lineages Book Club: Interest & Waitlist Form