Help me celebrate 25K followers by giving away 25 copies of The Dot Method to one hospital, clinic, or program supporting kids and families impacted by cancer.

Please complete this short form to nominate yourself or another professional or program.
Nominations are open through October 24th, and the selected site will be announced on October 25th (U.S. shipping only).

Name

First Name

Last Name

Hospital/Clinic/Nonprofit/Other

Your Title

Phone

(###)

###

####

Email

Shipping Address (US Only)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Message

Tell me a little about who The Dot Method workbooks will support or how they’ll be used.

I understand that submitting this form is a nomination only and does not guarantee selection.

Yes

I confirm that the nominated program is located within the United States (U.S. shipping only).

Yes

If selected, I agree to provide any additional details needed to facilitate shipment of the 25-book donation.

Yes

Help me celebrate 25K followers by giving away 25 copies of The Dot Method to one hospital, clinic, or program supporting kids and families impacted by cancer.

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