(Please print and mail with signed Agreement)
| NAME (First, Last): |
|
| TITLE and AFFILIATION: |
|
| ADDRESS: | |
| Street |
|
| City |
|
| State |
|
| Zip |
|
| Country |
|
| EMAIL: |
|
| TELEPHONE: |
|
| FAX: |
|
|
TAX ID# (needed to issue royalty payments) |
|
| TITLE: | |
| SUBTITLE: | |
| AUTHOR: | |
| CO-AUTHOR(s): | |
| PEER REVIEWERS: List 3 specialists in the field who are qualified
to review your manuscript. Provide name, title, affiliation, mailing address,
email address, telephone. |
|
|
Fees apply to books of 400 pages or less; 0.50c for each additional page. Paperback |
$800 |
|---|---|
| Hardcover | $900 |
| Hardcover & Paperback (together) | $1400 |
| Reprint - Manuscript is submitted as Word file - Optical scanning of hard copy book |
$800 TBD |
| Add 3% for online payment | |
| Total: | $____ |
___ I have paid online (link to online credit card processing on SUBMIT page).
___ I have enclosed a check or money order for the amount above
New Academia Publishing, LLC
P.O. Box 27420
Washington, DC 20038-7420