To fill out application, copy and paste into a Word document:

Binghamton Center for Writers

State University of New York

 

BINGHAMTON UNIVERSITY JOHN GARDNER FICTION BOOK AWARD 2013 Application Form

 

Name of Author ________________________________________________

 

Home Address _________________________________________________

(listing as c/o publisher may result in a delay; to receive early verification, list your own address)

 

Phone Number _(______)______-_________ E-mail ___________________

 

Social Security Number ________ - _______ - __________

(may wait for results to supply if you prefer)

 

Title of Book ___________________________________________________

 

______________________________________Cost of Book_________

 

 

Publisher_________________________________________________

 

Contact's Name at Publisher ______________________________________

 

Publisher's address _______________________________________________

 

___________________________________________________________________

 

Phone Number _(______)______-_________ E-mail ___________________

 

Date of Application ____________________________________________

 

 

I understand that books cannot be returned.

DEADLINE MARCH 1, 2014

 

Send three (3) copies of each book with application to:

 

Maria Mazziotti Gillan, Director

Binghamton Center for Writers - State University of New York

Department of English, General Literature, and Rhetoric

P.O. Box 6000

Binghamton, NY 13902-6000