Writer's Background Information and Release

The Fairfield Review
Writer's Background Information and Release

The following form may be completed and submitted on-line. Be sure to press the "Submit" button at the bottom of the form when you have completed it. Thank you.

NOTE: Do not press the Enter key until you have completed all of your entries.

How did you hear about us?
Salutation:
First Name:	required
Last Name:	required
Address:	required
City:	required
State/Province:	required
Postal Code:	required
Country:	required
Phone:
Fax:
Email Address:	required

Please tell us a few words about yourself and your writing for a brief biography to accompany the on-line publication of your writing.

1.	How would you like your name to appear in the magazine?
2.	What is your current (or former) occupation? Are you a student? Yes No If you are a student, what is your age? What is the name of your school? What is your grade of study?
3.	When did you begin writing? (i.e., for how many years have you been writing?)
4.	Why did you start writing? What was the motivation, the impetus, or the occasion?
5.	Have you had any of your work published? Yes No If so, where?
6.	Have you won any awards, contests, or formal recognition for your writing? Yes No If so, please list.
7.	Are you a member of any writing group or association? Yes No If so, which one(s)?
8.	Do you have a special quote or comment you would like included?
9.	Title(s) of your submitted or accepted work?
10.	Any other information we should have about your work when it is published? (e.g., copyrights, trademarks, footnotes, etc.)
11.	Do we have your permission to include your work in The Fairfield Review, our on-line magazine published on the Internet's World Wide Web, and in our archive web pages and print anthologies; and do you hereby certify that it is your original work, and hold The Fairfield Review Inc., its editors and employees harmless against any lawsuit that may result from the publication of this work? Yes. I accept these terms and conditions No. I do not accept these terms and conditions

If you are under the age of 18, we need to have a parent or guardian give their approval. Please have them complete the following:

Parent or Guardian First Name:	required
Parent or Guardian Last Name:	required
Parent or Guardian Address:	required
Parent or Guardian City:	required
Parent or Guardian State/Province:	required
Parent or Guardian Postal Code:	required
Parent or Guardian Country:	required
Parent or Guardian Phone:	required
Parent or Guardian Fax:
Parent or Guardian Email Address:	required

The Fairfield Review is published by the Fairfield Review Inc., a nonprofit corporation.

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Document last modified on: 04/18/2024