Please print the form form below (using the brower PRINT button), fill it out and return it with your check or money order payable to River City Romance Writers, or bring it to the next meeting.

(Please print)

I. Personal Information

Name___________________________________________ Pseudonym(s)___________________________________________

Birthday________________________________     RWA Membership Number*_________________________________________

Address________________________________________________________________________________________________

City/State/Zip____________________________________________________________________________________________

Home Phone_____________________________________     Business Phone___________________________________________

E-mail Address__________________________________________________________________________________________

Web site Address________________________________________________________________________________________

*You must be a member of RWA® to join RCRW.

II. Writing Information (Check All That Apply):

Are you Published?      ___________YES       ____________NOT YET

If YES, is your work:

_____Non-Fiction:   Type?_____________________________________________________________________

_____Fiction:   Type/Genre?____________________________________________________________________

Publisher(s)__________________________________________________________________________________

III. Main Field(s) of Writing Interest (Check All That Apply):

_____Traditional (sweet) Romance
_____Short Contemporary
_____Short Historical
_____Paranormal
_____Regency

_____Suspense/Mystery
_____Long Contemporary
_____Long Historical
_____Young Adult

_____Mainstream (women's fiction, straight suspense/mystery, etc.)
_____Other:______________________________________

IV. E-Mail Loops

1. Do you wish to join RCRWLink, the chapter's online discussion group?
_____YES       _____NO

V. Critique Matching

Are you interested in joining a critique group?    _____YES      _____NO

VI. Release of Information

River City Romance Writers must have your permission to include your personal information on our internal membership roster. This information is kept confidential and is released only to members of RCRW. Please complete and sign the release below.

I, (print name) ___________________________________________________________________________________, grant permission to River City Romance Writers, Chapter #23 of Romance Writers of America®©, to publish my personal information on the chapter's internal membership roster. I understand that this information will be kept strictly confidential.

Signed____________________________________________________________________ Date_________________________

VII. Payment

Dues are $36.00 per year, payable January 1. If you join after January 31, dues are pro-rated at $3.00 per month.

Number of months remaining in the year ______________ @ $3.00/month = __________________

Please return this form, along with a check or money order payable to River City Romance Writers, to:

River City Romance Writers
PO Box 4214
Cordova TN 38018-9998