Passionate Ink Member Details Form
RENEWALS: If you are renewing your membership and you'd like to keep your forum USERNAME (login name) as is and not change your password, you can enter "Same as before." YOU CANNOT DO THIS FOR OTHER FIELDS. You must complete ALL other fields again even if renewing, including your Pen Name. Completing this form in full is required for our due diligence with our RWA affiliation agreement. Thanks! -- PI Membership Director
Legal name {Surname, First) *
Please write your surname first, followed by your first name. This name will not be shown on the PI site or forum.
Your answer
RWA Name {Surname, First)
If you used the same legal name above, leave this blank. If you used a variation of your name *other* than your legal name to sign up with RWA (like another pen name), please provide that here so we can reconcile your membership with RWA.
Your answer
Pen Name (Forum Display Name) *
By default, this name will appear in your profile description and next to your photo for posts for your profile on the forum. You can also choose to use your legal name (just type it in again). Please provide at least two name options to ensure you get your choice of name. Feel free to include special notes here.
Your answer
RWA Details
RWA Number *
Please enter your RWA number. This number is REQUIRED to validate your membership with RWA. If you don't remember your number, it can be found next to your name on your email renewal receipt, sent to you from "Payment Support <>."
Your answer
RWA Expiration *
Please enter your RWA membership expiration date.
Your answer
Contact Information
Address *
Please enter your mailing address - number and street, city, state and zip code.
Your answer
Phone *
Please enter your phone number.
Your answer
Official PI Email Address *
Please enter the email address where you'd like to receive all PI member communications. This email address will also be used to set up your forum account.
Your answer
Other emails (payments, personal)
This is not a required question; however, if you will be sending messages to PI from multiple email addresses (like one for PayPal, one for your real life email, and one for your author's identity/pen name), it can get confusing for us to track the different email communications. If you can let us know what they all are in one place we can keep better track of who you are when you reach out to us! :)
Your answer
Website URL
Your answer
Social Media
Please enter YOUR TOP 3 ONLY profile/web links for your most frequently-used social channels (Twitter, Facebook, Pinterest, Google+, Tumbl, YouTube, Goodreads, Instagram, Tsu)
Your answer
Facebook Profile URL (For PI's Closed Group)
Your answer
Authors: About your work
Publications *
Has your work been published?
Please list your publishers, if any.
Your answer
Genre *
What is your primary writing genre?
Your PI membership visibility
Your listing on PI's RWA Chapter Site Roster *
RWA's rules for registration now require that we disclose all our members on our chapter roster on the RWA site ( To accommodate us, they have created PEN NAME fields for your Directory listing. (IMPORTANT: We will prioritize adding you by your PEN NAME if you provided one. If we can't find you within RWA's system by your pen name, that means you will appear as your main profile identity for RWA; but you can always go back in later and add your Passionate Ink Pen Name.)
List me on the site *
Would you like to be listed as a PI member author under your PEN NAME on the website?
Membership Level
Please confirm your RWA and PI membership status, then select ONE of the options below to confirm the details of your RWA membership class.
RWA Status *
Does RWA have you labeled as a General or Associate Member?
PI Status *
Are you a new or returning member of Passionate Ink?
Dues Membership Year *
Please confirm the membership year year you're signing up for at the time of this form submission. (The membership year runs from Oct 1 - Sep 30 of the following year. If you sign up during the month of September, please select the upcoming membership year!)
Are you currently pursuing a career in romance writing?
Publishing professional
Are you a publishing industry professional involved in acquisitions? If so, please tell us your occupation.
Are you a supporter of romance writing? If so, please tell us your occupation.
Final Details
Last steps, we promise!
PayPal Confirmation / Receipt No. *
So we can attribute your dues payment to the right person, please copy/paste your PayPal Receipt Number here.
Your answer
Membership Communications *
Please check the box below to acknowledge. We will never sell, release, or publish your contact information, including your email address or real name.
Membership PINS!
Please check the box below to receive your membership pin in the mail! RENEWING MEMBERS: Please only choose "yes" if you have NEVER received a pin before. If you have a PI pin, leave this space blank. If you would like to replace a lost pin, email to make arrangements. Thanks!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service