Alumni Author Series Information Form

Please complete the information below. Thank you for your participation. Information that is starred (*) will appear on our Web site.

Online Registration
First Name: Required*
Last Name: Required*
Street Address:
City, State, ZIP:
Home Number:
Daytime Number:
Email Address: Required
Alternate Email Address:
Fax:
Web Site*:
Agent: (if applicable)
U-M school(s)/college(s) attended*:
U-M Degree Year*:
Alumni Association Member?	Yes No
Author biography:

Title of Current Book*:
Price*:
Publisher*:
Date Published*:
Name(s) of co-author/illustrator*:
ISBN#*:
A brief summary of your current book: (genre and basic overview-please limit to 75 words)

Please list any other book(s) you have written: (Include the publisher(s) and year(s) published)

Are there any Michigan connections in your book(s) (ie, characters, places related to U-M, Ann Arbor, etc.)?: (Please specify)

Did your U-M experience/education influence your writing career/style/topic, help you to become a writer, etc.?: (Please explain)

Are you interested in appearing at Alumni Association and alumni club events? If so, please provide appropriate contact information:

Are there any areas of the country to which you travel regularly, either for pleasure or to promote your work?:

List any upcoming book tours/signings/appearances you have scheduled for the future:


Have you received any awards or recognition we should be aware of?:
List any influential contacts you know personally who might be willing to endorse your book. Include name, contact information and any U-M connections:
List any honorary degress you hold, either from U-M or other institutions:

Are you affiliated with any alumni or professional organizations? Clubs?:

This form will be forwarded to Sharon Morioka You can also fax it to her attention at 734.764.4506. You may contact Sharon with questions: smorioka@umich.edu or 734.763.9748.