Name of Book Club                                                                       

# of Members                  

Contact Person                                                                             

Mailing Address                                                                            
                           (street address, city. state, zip)

Phone                                                

E-mail                                                

Reading Selection Info Needed

Date Book is Being Discussed                                                     

Title of Book                                                                                

Author                                                                                          

Number of books to be ordered (best estimate)                             

10% Discount Agreement

In order to receive 10% discount on book club selections, you must agree to the following terms:

1. All members must agree to purchase the monthly selection exclusively from Octavia Books; a minimum of five (5) books must be purchased
2. Members must identify themselves as part of the book club listed above upon checkout
3. Discount is given for book club titles ONLY
4. Update us regarding new reading selection at least 3 weeks in advance of the meeting.

Signature                                                      Date