Readers Club
Application
Form
(Please Print and Complete Clearly and Legibly)
Name:____________________________________________________________________________________
Address:__________________________________________________________________________________
City:
Contact Phone: ____________________________ Email: __________________________________________
Date of Birth: ____/____/____ Gender: Male _____ Female: _____
Education:
What styles do you read? (Selecting only 5 genres, please list in order of preference from 1 – 5)
__ Adult Fiction
__ Adventure
__ African American
__ American Indian
__ Anthologies
__ Autobiography
__ Biographies
__ Business
__ Children’s
__ Cooking
__ Drama
__ Education
__ Family
__ Fantasy
__ Fiction
__ Gaming
__ Gay/Lesbian
__ Health
__ Healing – New Age
__ Healing – Traditional
__ Historical
__ Horror
__ How To
__ Humor
__ Inspirational
__ Medical
__ Memoirs
__ Mystery
__ New Age
__ Non-Fiction
__ Personal Empowerment
__ Philosophy
__ Poetry
__ Religious
__ Romance
__ Science
__ Sci-Fi
__ Self Help
__ Short Stories
__ Spiritual
__ Sports
__ Suspense
__ Thriller
__ Western
__ World View
__ Young Adult __ __
Favorite Authors (Please List 3)________________________________________________________________
I read _____ books per Week I read _____ books per Month
I would like to receive the manuscripts in the following format:
_____ Email _____ Hard (Paper) Copy _____ CD Rom
I would like to receive my funds in the following manner:
_____ Pay Pal Acct. _____ Money Order _____ Trust Fund
The following information is beneficial to us but is not required. All information received is kept confidential and is not shared with any individual, company or agency; federal, state, etc. The sole purpose of gathering this information is to give us a better understanding of you the person, the reader. This will also help us to understand how you may respond to certain material that you may be asked to read and to respond to. We want to make it clear that this information will not be stored on a computer, or shared with any one.
Religious Belief: _____ Christian _____ Jewish _____ Hindu _____ Buddhist
_____ Islam _____ New Age/Other _____ Spiritual _____ Non-Religious
Ethnicity: _____ Caucasian/White _____ African American/Black _____ Asian/South Pacific
_____ Hispanic/Latin _____ Middle Eastern _____ American Indian _____ Other
Sexual Identity: _____ Heterosexual _____ Homosexual _____ Bisexual
_____ Transgender _____ Transsexual
By completing this application form, it does not guarantee that you will be approved for membership in the Readers Club. Thank you for your time and effort
By submitting this application to the Readers Club program I fully understand that I am under legal obligation to not share any information about the books that I read for the Readers Club, or information and material from Wizard Consulting and Publishing. Any and all material that I receive will be kept confidential and private and I agree to follow the instructions provide by Wizard Consulting & Publishing on all material that I receive from Wizard Consulting & Publishing.
__________________________ __________________________
Printed Name Signature
__________________________
Date Signed