* Indicates Response Required

This form must be completed to ensure entry(ies) are submitted successfully.
* CONTACT INFORMATION
*Contact First Name: *Contact Last Name: *Company:
*Address: *City: Publicist:
*Phone: *State: Publicist_Assistant
*Fax: *Zip Code: *Email Address:
ENTRY FEES                
  APA Members — $85 per title entered.
Non-Members — $150 per title entered.
  Category Entry Title Author Narrator Publisher Date First Shipped
(mm/yy)		 Format Length $ Fees
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
           
TOTAL $:
*PAYMENT INFORMATION
*
*
*
*
*