EmailMe Form - Author Appearance Request Form

Host/Contact Name *

Email Address *

Phone Number

### - ### - ####

Name of Institution *

Address of Institution *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Please name closest airport(s)

Select a preferred date and time you would like for a visit. *

MM / DD / YYYY HH : MM AM/PM

Select an alternate date and time you would like for a visit.

MM / DD / YYYY HH : MM AM/PM

Available Budget for Honorarium (payment for visit) *

$ Dollars . Cents

Available Budget for Expenses (e.g., Travel) *

$ Dollars . Cents

Please describe presentation requested, including:
1) Number of sessions desired
2) Approx. number of students per session
3) Duration per session
4) Age range of students *

Will you be ordering books for the visit?

Yes

No

If YES, please select the titles you plan to request:

Wrinkles Wallace: Knights of Night School (Book 1)

Wrinkles Wallace: Fighters of Foreclosure (Book 2)

Wrinkles Wallace: Power of Parents (NEW! - Book 3)

Order straight from the publisher for a 25% discount on book list price here: https://www.emailmeform.com/builder/form/8UVN803arf OR email admin@meridiapublishers.com