The Authors Registry - Application Form

Authors Registry Application Form
There is no charge for authors who are members or clients of any of the organizations or agencies listed here. If you are not a member or client of one of these affiliated groups, there is a charge of $10 for listing your name and contact information with the Registry. Please check to see whether you are in an affiliated group, and, if so, enter the name of the group here:

If not, please send a check in the amount of $10, payable to "The Authors Registry, Inc." to:

The Authors Registry
31 East 32nd Street, 7th Floor
New York, NY 10016

Mention "Authors Registry form" in the memo portion of the check.

I. Confidential Contact Information

The following information will be used by the Registry to contact you regarding Registry business, such as updating the information in our computer. It will not be given to inquirers unless you authorize us to do so in section III below.

Name:

Address:

City:

State:

ZIP:

Fax:

e-mail:

Phone 1:

Phone 2:

If outside the United States:

Country:

Postal Code:

II. Name / Title Information
List all names and pseudonyms under which your works have appeared. If you occasionally use initials or other variant spellings of your name, please list each spelling of your name separately. Your name must appear exactly as it has in publications. Please provide one title published under each name. (Note: We do not maintain a listing of your publications. We use each title only to distinguish between authors with similar names.)

Name 1:

Book/Article Title 1:

Name 2:

Book/Article Title 2:

Name 3:

Book/Article Title 3:

Name 4:

Book/Article Title 4:

Name 5:

Book/Article Title 5:

III. Contact Information

If you do not wish to have professional inquiries transmitted, please leave the following section blank.
The Registry should direct professional inquiries to (select one):
Me
My Agent

Agent:

Agency:

Attorney/Other

(specify)

...at the following address (complete only the information that you want provided to inquirers):

Address:

City:

State:

ZIP:

e-mail:

Phone 1:

Phone 2:

Fax:

If outside the United States:

Country:

Postal Code:

IV. Signature / Authorization

I authorize the Authors Registry to release the non-confidential contact information in Part I to inquiring parties (the confidential contact information in Part III will not be released to inquirers).

Name:

Transmitting this form to the Authors Registry constitutes your consent to allow us to make the non-confidential contact information accessible through the Registry.

Questions or comments can be e-mailed to: staff@authorsregistry.org

Authors Registry phone: (212) 563-6920

Authors Registry fax: (212) 564-5363

Copyright ©2007 The Authors Registry.
All rights reserved.