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Proposed final title and subtitle for your book:
Your First Name: (required)
Your Surname: (required)
How you want your name to appear
on title page and in copyright:
Your mailing address:
Your physical street address for courier deliveries:
Your home address for royalty and tax purposes:
Your email address: (required)
Daytime telephone:
Evening telephone:
FAX:
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May we give out your email address?
May we give out your address?
May we give out your phone number(s)?
Date of birth (MM/DD/YYYY):
Help us call you by your preferred pronoun (e.g., he, she, they, rather not say):
Nation of citizenship:
Occupation and job title:
Have you already registered your manuscript for copyright?
If yes, please send a photocopy to your editor; this is very important.
Does your book have a dedication?
If your book has a dedication, please repeat the wording here:
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