EmailMe Form - Tandem Light Press Writing Contest Entry Form

Personal information

Name

First Last

Email

Phone

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

Address

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

Manuscript Information

Title of Work *

Select Genre *

Fiction

Non-fiction

Word Count *

Please select the most appropriate word count for your book and be sure to include the actual word count (not including title) on the front page of your submission.

Please provide a brief synopsis of your manuscript *

Is your work previously unpublished? *

Yes

No

Other

Authorship *

Submission & Payment Information

How will you be submitting your manuscript today?

File Upload

Payment will be made via: *

Mailed Check or Money Order

Credit Card

Other

Entry Fee *

Card Type *

Expiration Date

MM / YYYY

Card Number

CVV or Security Code

I authorize Tandem Light Press to charge my card or deposit my check within 60 days of receipt in the amount stated above. *

Yes

Signature *

Please add me to the Tandem Light Press Newsletter list

Yes, please

No, thanks

I would like to receive email updates.