Author Information Questionnaire (Form 10)

Your First Name: (required)

Your Surname: (required)

Proposed final title and subtitle for your book:

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: