AUTHOR, SUBJECT MATTER EXPERT AND REVIEWER APPLICATION

Personal Information
Name:    
Account / Institution of Employment:    
Department:  
Address:    
City:    
State:    
Zip:    
Office Phone:    
Home Phone:  
Fax:  
Email:  
Academic Information
Degree(s):  
Received From:  
Primary area of expertise:  
Topic Information
Topic I would like to write about or review for (topic or content area):    
I currently teach a course on this topic:

Current Enrollment for this course at my institution is:  
Current Book / Product In Use for this course: (Author/Title/Edition/Publisher):    
Past Experience
Are you/have you reviewed for other publishers?:
If yes, which publisher?:  
Are you/have you authored or written a text/product with another publisher?:
If Yes, please enter the publisher, title, and edition:  
Are you currently working on a text?