AnneWells.net Information Form

AUTHOR SEEKS MOTHERS OF ALL AGES TO INTERVIEW FOR HER NEW BOOK,
MOTHERS SPEAK: THE GOOD, THE BAD, THE UGLY… THE TRUTH, FINALLY, REVEALED!

Interview Information Form

If you are interested in being interviewed for Anne Wells' upcoming book: Mothers Speak: The Good, The Bad, The Ugly... The Truth, Finally Revealed!, please fill out this form and submit it.

First Name:

Last Name:

Email Address:

City:

State:

Phone:	(xxx-xxx-xxxx)

Ages of Children:	(age, age, age)

Career:

Why do you want to share your story with the world?:

* Your information will be kept private and will be used only by Wells Publishing to contact you regarding the book.