Author Info Form

Please supply this info so that we have your full contact info on file. In those fields where you have no response, please put N/A.

Name*
First Last
Email*
What E-mail Do You Use for PayPal?*
Home Phone*
Cell Phone*
Business Phone*
Alternate Phone (if applicable)
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Shipping Address*
- Same as Mailing
- Different Shipping Address (enter below)
Shipping Address (If different from Mailing Address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Time Zone
Social Media
Help us follow you! Please respond N/A for any that do not apply to you.
Primary Website*
Blog URL*
Facebook URL*
Instagram URL*
Twitter Handle*
LinkedIn URL*
Other Social Media
Your Audience
Do you have an email list? Please answer Yes or No.*
If so, what is the size of your list? Please respond N/A if you don't have a list.*
Do you post videos regularly? Please answer Yes or No.*
Do you have a podcast? Please answer Yes or No.*
Phone
This field is for validation purposes and should be left unchanged.

Social Media