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Author Information Questionnaire (Form-10)


Your name
What is your surname? (i.e., you are Mr./Ms. _________)
What is your proposed final title and subtitle for the book?
Show us precisely the way you want your own name
to appear on the title page and in the copyright notice
What is your mailing address?
If it differs from your mailing address,
what is your physical street address for courier deliveries?
If it differs from the above,
we need your home address for royalty and tax purposes
Daytime tel
Evening tel
FAX
E-mail
Date of birth (MM/DD/YYYY)
Gender male female
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.)		 yes no
Does your book have a dedication? yes no
If your book has a dedication, repeat the wording here