GET LISTED!

PLEASE READ CAREFULLY.

We suggest that you READ this whole form PRIOR to completing it so you may properly prepare (gather info details) for filling it out, as well as, understand the agreement, cost of only $179 and payment processing which is available quickly and securely via Paypal. Checks, credit and debit cards are accepted via Paypal and a Paypal account is not required.

Please allow 7-10 days for your CAN listing to be created and uploaded. Serious inquiries only. Please do not submit your information if you have not followed all of the above instructions. We appreciate your cooperation and we look forward to serving you.

General Information

Name:

Phone or Mobile number:

Fax number:

Email:

Website:

Your Bio (10 lines or less)

I am inserting my bio exactly as it appears in the box below.

Programs ( List the Title of Your Speech/es)

Title 1:

Title 2:

Title 3:

Fee/Honorarium Range

	Free
	Under $1500
	$1500-$3000
	$3000-$5000
	$5000-$7500
	$7500-$10,000
	Over $10,000

Geography

City:

State:

Travel From:

Book Information

Genre:

Current Release:

Available For Book Signings and Events:

	Yes (contact via email address, website or fax with request )
	No

Personal Photo

	I am emailing my PHOTO as an attachment in an email to authorrelations@goodgirlbookclubonline.com ( NOTE: The FORMAT of the photo file should be sent as an attachment via JPEG or GIF.)
	I do not want my photo listed.

Payment Method

SPECIAL NOTE: To join can requires immediate payment of only $179. Payment must accompany submission information or submission information will be immediately discarded.

PAYPAL: I agree to pay $179.

AGREEMENT

This agreement is for the listing of my information provided in this form for inclusion in the GOOD GIRL Book Club online author directory/network. I understand that a personal page will be created and listed in the online directory/network with the photo and information I have provided. I further understand that changes to the information provided in this order after submission will result in a pre-paid edit fee of $39. I further understand I am listed in the GOOD GIRL Book Club online author directory/network for one year, and my listing is available for renewal upon expiration if desired.

Name:
Date:

NOTE: GGBC suggests that your print a copy of this insertion order and agreement for your records.

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