Simply Woman Book Application Form

Simply Woman Book Compilation

Fill the form below accurately indicating why you believe you have a story that would fit our new book compilation - "Simply Woman: compelling and life-changing stories from trailblazers around the world."
*Please note: if you are having trouble filling out this form, please use Google Chrome.
Name:*

First NameLast Name
Birth Date:*

MonthDayYear
Phone Number:*

Area CodePhone Number
E-mail Address:*
Area of Residence:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Website (if applicable):
Social Media Account(s):
FacebookGoogle SearchTVTwitterThrough a FriendRadioSimply Woman MagazineThe S.W.A.T. InstituteOther
Your Story
Tell us a bit about you: your hobbies, what you do for a living, etc. *
Why do you feel you'd be a good fit for the new Simply Woman book compilation? *
Traumatic ChildhoodMental IllnessSick ChildPhysical Illness/InjuryLoss of Loved OneDivorceSexual AssaultAbuseAbortionWarOther
Tell us a bit about those hardships. We applaud you for your courage in sharing with us. *
How have you overcome your circumstances and changed your life?*
Tell us a bit about the story you'd like to tell. *
How are you prepared to sell copies of the book? What ideas do you have to promote?*
Please know that no matter the outcome, your story is very imporant! We appreciate your bravery in telling us a bit about your story, and thank you for your patience in us getting back to you.
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Simply Woman Book Compilation