Form test page – Dayton Literary Peace Prize

Title of Book *

Genre *

Fiction
Nonfiction

Author *

ISBN *

Please upload a 300 dpi full color book jacket image in .png or .jpg format *

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Please upload a 60-80 word blurb description for the book in .doc or .pdf format *

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Please upload a 300 dpi full color author headshot with photo credit in .png or .jpg format *

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Please upload a 150-200 word author biography in .doc or .pdf format *

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Nominator's Name and Title *

Publisher/Organization *

Nominator's Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Nominator's Phone *

Nominator's Email *

Website / URL

Agreement *

I have read, understand, and agree to the eligibility and submission requirements. *

$125 Nomination Fee is required with submission. Please choose your preferred method of payment below.

Choose your preferred payment method *

Credit Card
Check

Please note that submissions are considered pending until the check payment is received.
Proceed to submission form completion. If you are paying by check, please print the confirmation email and include in the envelope along with your check.