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					                             LexisNexis Centenary Book Award
                                                     2011 Entry Form
PERSONAL INFORMATION
Prefix
Surname
Given Names
Email
Contact Phone Number                      (h)                             (w)                           (m)
Address

Date of Birth
Country of Residence


SUBMISSION INFORMATION
Title of Book
Topic
Estimated Word Count
Proposed Target Market
Level of Readership

CONDITIONS OF ENTRY

        I, ................................................................., (print name) have read the terms and
conditions of the LexisNexis Centenary Book Award and I certify that all the information in this
application is true and correct. I agree to abide by all terms and conditions of the 4th LexisNexis
Book Award.



SIGNATURE .............................................................         DATE .....................................
Please submit your proposal electronically, with this completed entry form to bookaward@lexisnexis.com.au.
If it is not possible for an entry to be submitted electronically, hardcopy entries will be accepted, posted to:

LexisNexis Book Award
Attention: Susan Lin
Brand Marketing Manager
LexisNexis Australia
Tower 2, 475-495 Victoria Avenue, Chatswood NSW 2067

Email:    susan.lin@lexisnexis.com.au
Tel:      02 9422 2574




         Tower 2, 475-495 Victoria Ave. l Chatswood NSW 2067 l Tel: 02 9422 2222 I Fax: 02 9422 2444
                Locked Bag 222 l Chatswood Delivery Centre NSW 2067 l DX 29590, Chatswood
               A division of Reed international Books Australia Pty Limited l ABN: 70 001 002 357

				
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