Butterfly Dreamz Book Request

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2
What's your email address?* This field is required.
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Phone Number* This field is required.
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Which best describes you?* This field is required.
Middle School Girl
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5
Are you a member of our Cocoon Club? * This field is required.
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Thank you for your interest in our books! At this time, only Cocoon Club members can request free books. To join the club, visit cocoonclub.org/join. Membership is FREE for all middle & high school girls. Hit the "submit" button at the bottom right if you'd like to leave your contact information and/or any comments or questions.
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Which book are you requesting? * This field is required.
The Leadership Journal
Book Club Selection
8
Which type of book would you like?* This field is required.
An e-book (sent by email)
A hard copy (sent by snail mail)
9
Where should we send your book(s)?* This field is required.
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How many free books are you requesting?* This field is required.
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1
2
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How many free books are you requesting?* This field is required.
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1
2
3
4
5
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8
9
10
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Would you like us to invoice you for additional copies of The Leadership Journal?Please note: Your free books will be mailed out soon, and you will be emailed an invoice for the additional books you're purchasing.
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ORDER SUMMARY
Total costUSD
The Leadership Journal: Let's Talk
$15.00+Remove
Back
Quantity
Subtotal: $0.00
Total cost $0.00
13
Invoice ID
14
Please type the email address where you would like us to send your e-book:* This field is required.
example@example.com
15
Parent/Guardian Signature* This field is required.By signing below, I give consent for my child to read and receive a copy of the selected book(s).
Clear
16
Parent/Guardian Name* This field is required.
First Name
Last Name
17
Parent/Guardian Phone Number* This field is required.
Area Code
Phone Number
18
Parent/Guardian Email* This field is required.
example@example.com
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