Author Information Form

*Note: All fields marked with an asterisk (*) are required.
*First NameMiddle NameMaiden Name (if applicable)*Last Name*Mailing AddressAddress Line 2*City*StateCountry*ZIPPrimary Phone (include area code)Secondary Phone (include area code)*Email Address*Birthdate
*Country of Citizenship
PPPA only publishes the work of Seventh-day Adventist authors. Please provide the full name of the church where your official membership is held.
*Home Church*Working Title of Proposed Book
Your name as you would like it to appear on your book. Included titles, initials, etc., that you require.
*Author Pen Name