with Dianne E. Butts

Application due no later than April 16.

Date:	mm/dd/yyyy format
Title:
First Name:
Mid Init:
Last Name:
Address:
City:
State:	Select ** -- **Blank** AK -- Alaska AL -- Alabama AR -- Arkansas AZ -- Arizona CA -- California CO -- Colorado CT -- Connecticut DC -- District of Columbia DE -- Delaware FL -- Florida GA -- Georgia GU -- Guam HI -- Hawaii IA -- Iowa ID -- Idaho IL -- Illinois IN -- Indiana KS -- Kansas KY -- Kentucky LA -- Louisiana MA -- Massachusetts MD -- Maryland ME -- Maine MI -- Michigan MN -- Minnesota MO -- Missouri MS -- Mississippi MT -- Montana NC -- North Carolina ND -- North Dakota NE -- Nebraska NH -- New Hampshire NJ -- New Jersey NM -- New Mexico NV -- Nevada NY -- New York OH -- Ohio OK -- Oklahoma OR -- Oregon PA -- Pennsylvania PR -- Puerto Rico RI -- Rhode Island SC -- South Carolina SD -- South Dakota TN -- Tennessee TX -- Texas UT -- Utah VA -- Virginia VI -- Virgin Islands VT -- Vermont WA -- Washington WI -- Wisconsin WV -- West Virginia WY -- Wyoming
Zip:
Day Phone:
Night Phone:
Cell Phone:
Email:
Website:
Blog:

Please answer the following questions.

If you were a real whiz at Social Media, what book(s), speaking, or other product(s) would you want to get the word out about?

Characters Left

Do you currently have at least on ebook for sale on Amazon?

Characters Left

What online destinations do you have to send people to? (Website? Blog? Amazon author page? Facebook author page? Other? Please provide URL.)

Characters Left

List your current social media stats. Facebook author page Likes, Twitter handle(s) with # of followers, email newsletter list with number of subscribers, etc.?

Characters Left

In this clinic we will work primarily on the following social media platforms: Twitter, Facebook pages, Mailchimp newsletters, SEO for blog posts, Amazon author page, website on Wix.com. Do you feel you need help in there areas? And do you have a working knowledge of there, or at least are you fairly computer savvy? (If you use Wordpress, that's fine for a destinatio  and for our SEO segment, but know i cannot help you with your Wordpress blog or site.)

Characters Left

Do you have a basic working knowledge of Excel?

Characters Left

Can you bring a laptop to the clinic to work online?

Characters Left

What do you hope to gain from this clinic?

Characters Left

Verification Check:

Type the characters that you see in this picture.