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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code

If you have a writing-related business or organization name, enter it here.




If you charge for speaking, tell us what your speaking fee range is.
Web/Social Media Presence
Enter how we can find you on the web and social media.

Enter your website - http://your website

Enter your blog address if different than your website: http://yourblog

Enter your Facebook address - http://facebook.com/yourname

Enter your Twitter address - http://twitter.com/yourhandle

List your Instagram name: http://instagram.com/yourname

Enter your LinkedIn address : http://linkedin.com/yourname

Include any other social media listings you use.
Thank you!