STAR Super Saturday Registration Form

Name:____________________________________________

Address:__________________________________________

_________________________________________________

_________________________________________________

Email Address:______________________________________

Phone Number:______________________________________

STAR member? Y or N

Member of other chapter? Y or N

If Yes, that chapter is:___________________________________

Interested in pitching to: Diana DeBalko or Angela James (circle one)

For Pitch Appointment:

Name of Manuscript:__________________________________

Word Count:______________ Finished? Y or N

Genre:_____________________________________________

Interested in participating in cold reads? Y or N

I am: PRO PAN Unpublished (circle one)

If PAN, list publisher(s):__________________________________

____________________________________________________