Author ______________________________________________________

SS# (US citizens) ______________________________________________

Apt, Suite ____________________________________________________

Address _____________________________________________________

City, St, Zip __________________________________________________

Country _____________________________________________________

Telephone ____________________________________________________

Email ________________________________________________________

Author’s web URL ______________________________________________

Title of work ___________________________________________________

Subtitle _______________________________________________________

Approx. pages __________________________________________________

Advisor(s) _____________________________________________________

Discipline ______________________________________________________

Degree & Date __________________________________________________

Institution ______________________________________________________

City, Country ___________________________________________________

Keywords (not in title) _____________________________________________

Print out two copies of the agreement. Keep one copy for your files and send the other copy signed with your submitted materials, completed forms, electronic files & fee to:

The Kingdom of Hearts

2218 Navy St

Santa Monica, CA 90405 US

Any questions, please contact us at admin@tkoh.org