Personal Data

Last Name   First Name
Nationality   Date of Birth   (day/month/year)
Sex  female   male
Address   E-Mail 1
    E-Mail 2
    Telephone
    Mobile phone  

Proposed translation project
Author
Title
Publisher
Target language
Source language
Literary genre
Number of pages
Publisher of your translation project  

Most important translations to date
1. Author
Title (in the original language)
Title (translation)
Publisher and date of publication 
ISBN
2. Author
Title (in the original language)
Title (translation)
Publisher and date of publication 
ISBN
3. Author
Title (in the original language)
Title (translation)
Publisher and date of publication 
ISBN

Proposed length of stay at Looren Translation House
From (TT/MM/JJ)   to (TT/MM/JJ)

Miscellaneous
How did you hear about Translation House Looren?

Comments
Place and date
Enclosure
Curriculum vitae
Publishing contract