Alistair MacLeod Award for Short Fiction

This form is to completed for each title submitted by publishers (or self-published authors) for consideration by the jury for the Alistair MacLeod Award for Short Fiction.

Full Title of Book*

Author's Name*

Author's Email Address*

example@example.com

Author's Phone Number (beginning with area code)*

Please enter a valid phone number.

Author's Permanent Address (must not be a seasonal residence)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is this book self-published?*

No.Yes.

Publishing House/Press*

Name of Publisher Contact*

Publisher Contact's E-mail Address*

example@example.com

Publisher Contact's Email Address*

Publisher Contact's Phone Number (beginning with area code)*

Publishing House/Press's Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I, the publisher of the above title, hereby submit the above title for consideration by the award jury for the Alistair MacLeod Award for Short Fiction, and acknowledge that*

The author of the above title is a full-time resident of one of the Atlantic provinces (Newfoundland, New Brunswick, Nova Scotia or Prince Edward Island).The submission of the above title is accompanied by five (5) units of the title, sent by mail to the Cabot Trail Writers Festival Society (Alistair MacLeod Award for Short Fiction Jury; c/o Cabot Trail Writers Festival Society; Box 40; Grand Etang, N.S. B0E 3A0).I am submitting the application fee of $41 online or by cheque (see below to select a payment option).If the above title is shortlisted, I will, within 30 days of shortlist notification, provide two (2) additional units of the title to the Cabot Trail Writers Festival Societyand a $300 shortlisting fee (to offset travel costs and promotion costs) to the Atlantic Book Awards Society.

Date*

Date

Publisher signature*

I, the author of the above title, hereby submit the above title for consideration by the award jury for the Alistair MacLeod Award for Short Fiction, and acknowledge that*

I, the author of the above title, am a full-time resident of one of the Atlantic provinces (Newfoundland, New Brunswick, Nova Scotia or Prince Edward Island).The submission of the above title is accompanied by five (5) units of the title, sent by mail to the Cabot Trail Writers Festival Society (Alistair MacLeod Award for Short Fiction Jury; c/o Cabot Trail Writers Festival Society; Box 40; Grand Etang, N.S. B0E 3A0).I am submitting the application fee of $41 online or by cheque (see below to select a payment option).If the above title is shortlisted, I will, within 30 days of shortlist notification, provide two (2) additional units of the title to the Cabot Trail Writers Festival Society and a $300 shortlisting fee (to offset travel costs and promotion costs) to the Atlantic Book Awards Society.

Date*

Date

Author signature*

I prefer to submit the $41 application fee*

By mailing a cheque.By paying on-line.

Pay Fee By Cheque

Please make cheque out to the Cabot Trail Writers Festival Society and send to the below address:

Alistair MacLeod Award for Short Fiction Jury
c/o Cabot Trail Writers Festival Society
Box 40
Grand Etang, N.S. B0E 3A0

Pay Fee On-line

Application Fee for Alistair MacLeod Award for Short FictionThis fee covers the application fee for submission of one title for consideration by the award jury for the Alistair MacLeod Award for Short Fiction

$41.00CAD

Total

$0.00CAD

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Alistair MacLeod Award for Short Fiction

TITLE INFORMATION

PUBLISHER INFORMATION

PUBLISHER DECLARATIONS

AUTHOR DECLARATIONS

Application Fee