RWA-SD MEMBER APPLICATION FORM 

 * = REQUIRED                                  NOTE: DO NOT USE THE RETURN KEY TO ADVANCE.
According to IRS requirements, dues are not deductible as a charitable expense, but may be deducted as a business expense.

First Name *
Last Name *
Pen Name
     Roster & Website Real Name  Pen Name  Real Name w/a Pen Name
Date (mm/dd/yyyy) *
Membership *
New Member   Renewal  Associate
Street Address *
City *
State *
Zip Code *
Phone *
Cell Phone
Email *
Fax

RWA National Status*

 Member   Number   
Applied    Have Not Yet Applied
RWA PAN Status *
Yes
No
RWA PRO Status *
Yes
No
How did you learn about us? *
What is your writing background? *
Are you published in Romance? *
Yes
No
Are you published in another Field or Genre? 
Yes  Field 
No
Special Interests
Birthday(mm/dd)
Comments
Newsletter by
Snail Mail *
Yes
No
Email Loop *
Yes
No
Payment Method *
Check    PayPal


              



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