MRW Membership Form 2021-2022
Email *
First and Last Name (Legal Name) *
Town and State (Country if applicable) *
Phone Number *
Pen Name
Website
PERSONAL FB page URL (not your AUTHOR group page) where we can friend you and then add you to our CLOSED MRW FB group
Check all that apply *
Required
How would you like your meeting name tag to read?
Clear selection
May we share your contact information with the current MRW membership? (Check all that apply) *
Required
What genres do you write? (Check all that apply) *
Required
Membership new: $35 ($15 Jan-March) Renewal: $30
Membership dues run July 1, 2021-June 30, 2022. (Membership renewals for 22/23 will start in May 2022).
CURRENT MRW MEMBERS: I request to use Funds from the SUNSHINE FUND to pay my annual dues for 2021/2022 (this is a confidential request and seen only by the President, Membership Chair & Treasurer)
Clear selection
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy