PPRW Membership Application
Pikes Peak Romance Writers
Chapter 71 of Romance Writers of Americaź
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Please print
and mail completed form with your membership dues to:
PPRW
Chapter of Romance Writers of Americaź
P.O.Box 62943
Colorado Springs, CO 80962-2943
Name:
____________________________________________________________
Address:
__________________________________________________________
City:
______________________________________________________________
State:
_________________
Zip Code:
______________
Birthdate
(minimum age of 18 required): __________________________
Since
membership in Romance Writers of America is a requirement to join PPRW, please list your
RWAź
Membership Number: ______________________
RWAź
Renewal Month: _____________________
Home Phone
Number: (______) ______-___________
Work Phone
Number: (______) ______-___________
Cell Phone
Number: (______) ______-___________
Fax Number:
(______) ______-___________
Email:
_______________________________________
Do you have
a website? Yes / No
(print the
URL here): ____________________________________________
Would you
like your website linked to ours? Yes / No
May we publish your name on our website? Yes / No
If so, may we link your name to your email address? Yes / No
Are you published? Yes / No
In Fiction? Yes / No
In Non-fiction? Yes / No
Articles? Yes / No
List any
published works you'd like us to know about:
________________________________________________________________________________
________________________________________________________________________________
List any
areas of expertise you might be willing to share with the group or individual members
(this can include past or present occupations, education, life experiences, places you've
lived or visited, anything you're knowledgeable about):
________________________________________________________________________________
________________________________________________________________________________
What
Genre(s) do you write? ________________________________________
Pseudonym(s):
___________________________________________________
Would you
like to be on our loop? Yes / No
In order to provide the chapter with a wider variety of programs, are you willing to
receive your newsletter online through PDF downloads? Yes / No