First Name

Last Name


Phone Number


Email


Website?


Mailing Address


City


State


Zip Code


How did you find Advantage Media Group (AMG)?
Please select one Advantage team member Forbes magazine Inc. magazine Sharing Ideas magazine Speaker magazine Information Marketing Association National Speakers Association Glazer-Kennedy Online Other Referral

If other or a referral, who?


Please provide a brief (75 words or less) biographical sketch:


Do you speak to or interact (training, consulting) with groups of people on a regular basis?
Yes No

What is the average size?


What is the average frequency?

     Tell Us About Your Manuscript or Book Concept

Give a brief (150 words or less) description or synopsis of your book:


Is the manuscript complete?
Please select oneYes No it is 75-99% complete No it is 50-74% complete No it is 25-49% complete No it is less than 25% complete No it has not been started

Would you like help formulating and writing your book?
Yes No

Would you like help marketing and/or publicizing your book?
Yes No

Have you published a book before?
Yes No

If yes, please list the title, number of copies sold, and primary sales method.


Is there a target date to have the book released? If so, when is it and is it an event?


What are your desired method of selling the book?
Please select one Back of Room sales Personal website Amazon.com and online retailers Physical bookstores Corporate/Group sales

Are you the final decision maker for this publishing project?
Yes No

If no, who else is involved?


Do you have a budget for your publishing project?
Please select oneYes $10K or less Yes $10-30K Yes $30-50K Yes $50100K Yes $100K + No I have not established a budget but I am willing to do so No I am not willing to financially invest in this project

     Common Problems Most Entrepreneurs, CEOs, and      Business Leaders Experience