APPLICATION

Date:_________________________________

Name__________________________________________________

Address________________________________________________

City______________________________________

State________________

Zip Code____________

Home Phone __________________________________

Cell Phone________________________________

Web Site address_______________________________________________

Blog address_____________________________________________

Articles Published __________yes   _____________no

(if you would like this listed on your portfolio, please send)

Books Published ___________yes  _____________no

(Titles, Debut Date, Publisher…please send this)

Copy and paste this into an email and send to:

ccwriters2@aol.com