Your name:
Mailing Address:
Phone: Fax:
Email Address:
Website Address:
1. About Your Monograph
a. Suggested Title:
b. Approximate number of double-spaced manuscript pages:
c. When will your monograph be ready for publication?
d. Have any portions of the information you plan to include in the monograph been previously published?
e. Do you own the copyright to this material?
2. About You as an Author
a. Are you the only author? If no, list the names of the co-authors. Answer b-c for each author. This information will be used to market your monograph.
b. Why are you an expert on this topic? Describe any relevant life experiences, professional credentials, work experience, and prior publications related to the topic of your monograph.
c. What societies/organizations/websites, etc. are you involved with that might be interested in promoting/purchasing this monograph?
3. Attachments
a. Please attach an outline of what you plan to cover in your monograph. Be sure to include clinical applications of your topic. Keep in mind that your target audience is health providers who work with pregnant and breastfeeding mothers. This might be a lactation consultant, physician, nurse, dietitian, La Leche League leader, WIC staff, WIC peer counselor, doula, midwife, etc.
