Membership Application Form

For the Inland Empire Chapter #63 of Romance Writers of America ®

You must first be a member of the national Romance Writers of America to join any local or online chapter of the organization.

Once you have your membership number in RWA, you may apply for membership in IECRWA.

Instructions:

1. Using the form below, fill in the appropriate information. Starred items (**) are required. Submit the form
2. Use the Pay Pal button to remit your membership dues.
   -Membership begins April 1.
   -Dues will be pro-rated 50% ($12.50) for new members joining the chapter after October 1.
3. if you prefer to pay by check or money order, please email the Treasurer for the mailing address.
4. If for whatever reason, your membership is not acknowledged, or if you have questions, please send an email to IECRWA Membership Committee

** Name:

** Address:

** City, State and Zip:

** Home Phone:

Work Phone:

Cell Phone: (Optional)

** Email:

** RWA Membership Number:

** Birth Date:

Web Site URL:

How Long Have You Been Writing:

Are you Published?

Yes
No

Publication Credits:

Pseudonym?:

What genres do you write? (Please check all that apply):

Contemporary
Historical   Time Period:

Western USA
European
Medieval
Regency
Other Historical

Fantasy
Inspirational
Futuristic
Time Travel
Paranormal

Vampire
Werewolf
Shapeshifter
Other Paranormal

Erotica
Suspense/Mystery
Other

If you checked other, please enlarge on your answer:

How did you hear about IECRWA?

 

I fully understand the level of responsibility I have accepted with membership to IECRWA.

I will faithfully adhere to the purpose and bylaws of the Inland Empire Chapter of RWA.

Yes
No

Date of Application:

How are you paying your membership fee?

Paypal
Check or Money Order

Pay your membership dues now.

As soon as we accept and acknowledge your payment and your successful membership application, you will hear from us with membership information, an invitation to join our discussion lists, and much more Member Only information.

We look forward to seeing you at our next meeting! Check the Events page for details.

Welcome to IECRWA!