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Name |
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Address |
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E-mail
Address |
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Telephone Number |
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Fax
Number |
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Your
work has been: |
Published
Unpublished
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Do you
have a literary
agent appointed?
:
If 'Yes' give
all information,
including the
name of the
agent, the name
of the original
publisher, the
date of its
first issuance
and who has the
right to its
cover, pictures
and/or photos. |
Yes
No |
If your
work has been
previously
published,
include all the
necessary
information
regarding the
copyright
holder, the name
of the original
publisher, the
date of its
first issuance
and who has the
right to its
cover, pictures
and/or photos.
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Date
_________________________________________
I hereby declare
that I have read and
understand the terms
and conditions of
this application and
I hereby agree to be
bound by these terms
and conditions.
Signature
______________________________
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COPYRIGHT ©
2001-2007 HAKUROSYA ALL RIGHTS
RESERVED. |
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