Q1	On average, how many poetry books do you read in a year?
	0-5    6-16    17-40    more than 40
Q2	On average, how many new books (all genres) do you buy in a year?
	0-5    6-16    17-40    more than 40
Q3	How many arts organizations (nonprofit publishers, theaters, museums, etc...) are included in your annual charitable giving?
	0-3    4-7    more than 7
Q4	First Name Last Name
Q5	Email
Q6	Address Line 1 Line 2 City State Zip Check this box if your shipping address is the same as above.
	Shipping Address First Name Last Name Line 1 Line 2 City State Zip
Q7	Select your free poetry book.
	In the Next Galaxy by Ruth Stone Rampant, by Marvin Bell More Than Peace and Cypresses, by Cyrus Cassells Black Box, by Erin Belieu The Roads Have Come to An End Now: Selected and Last Poems of Rolf Jacobsen, translated from Norwegian by Robert Bly, Roger Greenwald and Robert Hedin The Separate Rose, by Pablo Neruda, translated from Spanish by William O'Day Angle of Yaw, by Ben Lerner What's Written on the Body, by Peter Pereira
Q8	Donation
	$5    $10    $25
	Fill in your amount $
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