Please complete this form by Thursday, October 22 by 12:00PM.

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

We'll be in touch soon.

First Name

Phone *

Email *

Address *

Street Address

State

City

Postal Code

Website

Industry *

Getting to Know You

Describe yourself and your business in a few words.

What type of book opportunity are you interested in?

Solo Book

Solo Book Group (writing your own book alongside a small group of authors)

Anthology (writing a chapter to a collaborative book)

If you selected Anthology, which anthology book are you most interested in contributing to?

Undeniable by Design

The Fractional Edge

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Writing Experience

Why do you want to write and publish?

How would you describe your level of comfort with writing?

Coaching and Support

Have you participated in a paid coaching program before?

If yes: Briefly tell us about the experience

Please list any additional information you wish to share.