Your full name:
Your email address: (e.g.: you@aol.com)

Were you referred? (By Who?):

Address:
City/Town:	State/Prov.: Post./Zip Code:
Country:

Website address:

Did you attend the online conference in 2001?   Yes   No 

Please Check If You Are:

Aspiring Romance Writer  

Aspiring Fiction Writer  

Romance Reader  

Fiction Reader  

Freelance Writer  

Published Writer  

Literary Agent  

Publicist  

Editor/Publisher  

Book Seller  

Suggestions for workshops(let us know what you would like to see at the conference

Would you like to be added to our mailing list?   Yes   No 

(The entire form needs to be filled out to be included)

The most referrals to the conference will win a prize, tell a friend