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Author ______________________________________________________

SS# (US citizens) ___________________________________

Apt, Suite _______________________________________

Address ______________________________________________

City, St, Zip ________________________________________

Country ___________________________________________

Telephone _________________________________________

Email ___________________________________________

Author’s web URL __________________________________

Title of work _____________________________________

Subtitle __________________________________________

Approx. pages __________________________

Advisor(s) ________________________________________________________________

Discipline __________________________________

Degree & Date _______________________________________

Institution ________________________________________________

City, Country _____________________________________________

Keywords (not in title) _________________________________________

Print out two copies of the agreement. Keep one copy for your files and send the other copy signed with your submitted materials, completed forms, electronic files & fee to: