Join WisRWA - WISCONSIN Romance Writers of America

Members Only

2011-2012 Application for WisRWA Membership

Date:
Name:	(Please use the same name as your RWA registration)
RWA Number:	(on label of RWA magazine)
(To join WisRWA, you must be a member of RWA. Membership will be verified.)
Address:
City:
State:
Zip:
Email Address:
E-mail List:	Please add me to the WisRWA e-mail list It is okay to publish my e-mail address for member use only Please don't publish my e-mail address
I am located in, or closest to, the following area:	Chippewa Falls Area Greater Green Bay Area Milwaukee Area Wausau Area Other
Memberships:	RWA PRO Member RWA PAN Member
I am published in book length fiction:	Yes No
Area of interest (i.e. romantic suspense, single title, etc.):
I am published in the other following areas:
Pseudonym:
How would you like to be listed on the WisRWA member page?	Real Name Pseudonym Real Name writing as Pseudonym
I would be willing to volunteer for the following:	Contest Category Coordinator Contest Judge A Newsletter Article Future Board Member Help With Conference Present An Area Meeting Program
I understand the above information may, unless otherwise indicated, be published and used for the purposes of promoting WisRWA and will be available to all WisRWA members.
Membership dues are $25.00 and cover the period between November 1 - October 31. Dues paid between November 1, 2011 and May 31, 2012 will be renewable on November 1, 2012. Dues paid between June 1, 2012 and October 31, 2012 will be renewable on November 1, 2013.
Pay with PayPal (use button on the Join WisRWA page):
PayPal amount:
PayPal Transaction Number:
Your PayPal email address:
Dues not deductible as a charitable expense, but may be a business expense.

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