Urban Legends Data Request From

Name *

First

Last

Email *

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Website / URL

Emergency Contact/Assistant (Name and Number) *

Instagram Handle *

Facebook Page (link) *

Twitter Handle

Two personal/original quotes *

Do you wish to headline a book signing/talk session during Black Writers Weekend? *

Please tell us the name & email of your guest *

Would you like to attend any of the following? *

Will you want to be interviewed in our media/press room? *

Head Shot (professional image) *

please submit a professional headshot

Book Cover (front cover only)

please submit your latest book cover

You acknowledge and give AAMBC Inc. permission to use your likeness and image during the marketing of Black Writers Weekend. *

please type your name

Name