Please complete as much information as possible so we can understand your goal in writing.

This form will take approximately 5 minutes to complete. Please answer each question thoughtfully and honestly. There are no right or wrong answers.

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First Name

Phone *

Email *

Address *

Street Address

City

State

Postal Code

Website

Industry *

Getting to Know You

Describe yourself in a few words.

Are you interested in a solo book or a book collaboration?

What is your preferred name for publication and print materials?

What is your level of education?

Writing Experience

Why do you want to write and publish?

How would you describe your level of comfort with writing?

Timeline

How soon do you wish to be published?

What gets in the way of your success day-to-day?

Coaching and Support

What is the biggest part of writing a book you feel you need support?

Have you participated in a paid coaching program before? If so, describe your experience.

Have you published previously? (If so list titles)

Please list any additional information you wish to share.