Author Information Questionnaire (Form 10)

    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:

    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: