AUTHOR VISIT REQUEST FORM
1. Contact Information
Contact Person
*
First Name
Last Name
Your Role
*
Please Select
Teacher
Librarian
PTA Coordinator
Other
School Name
*
School Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Preferred Contact method
*
Please Select
Email
Phone
2. Visit Logistics
Preferred Date
*
-
Month
-
Day
Year
Date
Backup Date
*
-
Month
-
Day
Year
Date
Preferred Time
*
Please Select
9:00-10:00
10:30-11:30
12:00-1:00
1:30-2:30
Session Length
*
Please Select
15 min
30 min
45 min
Grade Levels
*
Please Select
Pre-K/K
1-2
3-5
Number of Students
*
Location
*
Please Select
Classroom
Library
Auditorium
Other
Will you provide a microphone/speaker
*
Please Select
Yes
No
3. Read Aloud
Book Selection
*
Please Select
Seraphina: Heroes of the Sea!
Sea Amigos: A Trip Back Home
Theme/Topic
*
Please Select
Career Day
Kindness
Holiday
STEM
Activities Requested
*
Please Select
Q&A Session
Writing Workshop (Specify topic: ________)
Book Signing (Pre-order link: [Your Bookstore Link])
Craft/Activity (E.g., “Draw Your Own Character”)
How did you hear about me?
*
Submit
Should be Empty: