Chloe, the Mom Doctor: Chloe, la Doctora de las Mamás

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To order your personalized autographed book, please complete the order form -The cost is $15 for an autographed book that will be mailed to you. A portion of the proceeds is going towards gifts for caregivers.

Email *

Full Name (Mailing Address where book will be delivered.) *

Street Address (P.O. Box) *

City, State and Zip code *

Number of books (All will be mailed to address above) 1=$15, 2=$30, for 3 or more ($12 each) *

1st copy - Write the name(s) and message the book will be dedicated to... *

2nd copy - Write the name(s) and message the book will be dedicated to...

3rd copy -Write the name(s) and message the book will be dedicated to...

Telephone number (in case there is a challenge) *

Would you like to receive updates or be invited to future events? (Your information will NOT be given to third parties.) *

Yes

Maybe

Form of payment... (Please type name in comment box) *

CashApp - $DiaUS

PayPal - PayPal.Me/Diakoneo

Venmo - @Diakoneo

Check payable to "Diakoneo" - PO Box #813. Glenside, PA 19038

Cash - Mail to... PO Box #813. Glenside, PA 19038

Comment/ Note (optional):

A copy of your responses will be emailed to the address you provided.

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