Date:_______________

Send a Gift Book Each Month to:

_______________________________________________________________

________________________________________________________________

________________________________________________________________

Information about the reader: Biographical and literary interests, as far as
you know:

(If the gift is for a child, please include date of birth___________)

Name of Donor: __________________________________________________________

Telephone or e-mail _______________________________________________________

Credit Card Number ___________________________ Ex. _______

Instructions:

Send a book:
___each month for one year
___ every other month for a year
___ other (If other, please explain.)

Send:
___Hard cover
___Softcover
___Mixed

Special instructions, if any:

Questions?
Call (410-820-0324) or e-mail Caroline Ketcham at cgtketcham@goeaston.net.
You may return this form to Caroline via e-mail or snail-mail to the following address:

Politics and Prose
5015 Connecticut Ave. N.W.
Washington, D.C. 20008
Attn: Book Each Month Program