Energy4Learning Book Club Registration

Continuous personal growth is the hallmark of a professional. Join us  for a series of online facilitated discussions, starting with John Ratey’s Spark
spark-energy4learning-book-club-fact-sheet

Step 1: Fill out the registration form

* Required

Please type your last name. *

Please type your first name or nickname. *

What is your preferred email address? *

What is your preferred phone number? (This number will be used for Book Club purposes only.) *
Please include your area code. Example: 345-678-9800

Are you registering as a part of a group or as a single reader? *
 Group (2 participants=$85, 3=$125, 4=$150)
 Single - $45

Please list the names of ALL individuals that will be participating in the Book Club with you. *
Please include your name and separate names with a semicolon
Example: Bill Bobb; Steve Dunnbe; Suzie Wright

How much time will you or your group need to complete the entire book? *

What is the preferred frequency of your Book Club Meetings? *

How much time will be needed for your Book Club Meetings? *
 15 minutes
 30 minutes
 45 minutes
 1 hour

Would you like Fizika to purchase your book(s) and ship directly to you? *
 Yes
 No
 Other: 

Which payment method do you plan to use? *
 PayPal
 Visa/Mastercard
 Personal Check
 Purchase Order
 Other: 

Please indicate any questions or concerns you have about your Book Club order.

Please press the green “Send” button before proceeding to Step 2.


Step 2. Pay for your registration

You may use your credit card or PayPal account.

One participant = $45
Two participants = $85
Three participants = $125
Four participants = $150

Please enter your payment amount:
$