Electric 18s Membership Application
First Name *
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Last Name *
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Pen Name
(if applicable)
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Publisher *
(include imprint if applicable)
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Title *
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Agent/Agency *
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Blurb *
(2-3 sentence description of your book)
Your answer
YA or MG? *
Category *
(Contemporary, Adventure, Fantasy, Sci-Fi, etc)
Your answer
Anticipated Publication Date *
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Link to the OFFICIAL ANNOUNCEMENT of your book sale *
Please do not apply until after your announcement has been made. In the event that you do not have an official announcement, please explain in the box below and we will contact you for additional information in order to determine eligibility. If possible, do not send links to Publishers Marketplace as this reqiures a paid subscription.
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Brief Bio *
Please write this in the third person.
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Email Address *
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Your website
(if applicable)
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Your Twitter handle
(if applicable)
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Your Facebook page
(if applicable)
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Your Google + Page
(if applicable)
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Your Goodreads Author page
(if applicable)
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Your Book on Goodreads
(if applicable)
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Other social media
(if applicable)
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Your location (city/state or country if outside US) *
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I certify that: *
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My imprint or its parent publisher is listed in: *
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