2017 Writer's Row Booth Registration
(Application MUST Be Typed)
Writer's Row Application Prerequisite
This application is for self-published authors that have between one to three published titles. You must have a hard copy of your book at the time of application before continuing with this form. If your book is not in production as of today, please wait until you have a hard copy of the book or your application will be rejected. Upon submission of your application and payment, a hard copy of your book will need to be sent immediately to the following location:

Attention To: Exhibitor Coordinator
Miami Dade College - Freedom Tower
300 NE 2nd Avenue
Miami, FL 33132

*Writer's Row booths are not to be shared by multiple authors, as each booth is limited to one author and presenter*

Book Title: *
(If presenting two or three titles, please only list the premier title you plan to present)
Your answer
Author Name: *
Your answer
Contact Person:
(If exact same as Author Name, you may leave blank)
Your answer
Contact Address: *
Your answer
City: *
Your answer
State: *
If not located or based in the United States, please specify your full address in the "Other" field below
Zip Code: *
Your answer
Other
If not located or based within the United States, please provide your full address below
Your answer
Phone Number: *
(Home or Business)
Your answer
Cell:
Your answer
Fax:
Your answer
Website:
Your answer
Email: *
Please note that we communicate through e-mail. Make sure you provide us with a valid e-mail address that you check on a regular basis, and that you add Ghernan3@mdc.edu, Rjimene4@mdc.edu and Zachary.Fetaru@img.com to your contact list to avoid any of our emails being sent to your spam folder.
Your answer
Federal ID# (For Florida Tax Collection) *
If no Fed ID#, exhibitor must provide Social Security Number upon submitting payment
Your answer
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