CBW-LA Speakers Form

CBW-LA SPEAKER FORM

Please fill out the form below to help us set up your registration page.
Name *
E-mail *
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Legal Name (if different from author name-this is what we will use on the check)
Author Website
Other Social Media Sites (put N/A if none)
Author Bio *
Author Photo *
Book Title *
Book Summary *
Book Cover *
Link to Buy Book
Book Price *
Proposed Workshop Date *

Month Day Year
Date
Title of Proposed Workshop *
Description of Proposed Workshop *

CBW-LA SPEAKER FORM