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Daughters of Lineages Book Club: Interest & Waitlist Form
This form is a gentle first step. You’re welcome to share only what feels comfortable.
Full Name
*
First Name
Last Name
Preferred Name (if different):
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Are you 18 years or older?
*
Yes
No
Do you identify as a Black woman or a woman of color?
*
Yes
No
I 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)
*
Fiction
Nonfiction / memoir
Essays / articles
Poetry
Cultural or spiritual texts
A mix of everything
Are you interested in a weekly book club?
*
Yes
No
I Prefer Not To Say
What days/times tend to work best for you?
*
Weekday evenings
Weekends
Flexible
The book club is expected to be $25 per session or $75 monthly. Does this feel accessible for you?
*
Yes
Possibly
No / 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?
*
Yes
No
How did you hear about us?
*
Please Select one
Friend or community member
Social media
Website
Therapist or provider
Newsletter or email
Community organization or event
Other
If other, please specify.
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