To be submitted to June Brittingham and the MLA office, by December 31, 2010. All fields, except the Other Information field, are required.

Title

Author

ISBN

Publisher

Number of Copies

Price

Division Sponsoring Program

Program Title

Will Presenter Sign Books? Yes No

Program Contact

Contact Name

Email

Phone

Fax

Other Information

If you have any questions, please contact June Brittingham.

Please verify all information before submitting this form. Thank You.