- Low Country Romance Writers - http://lowcountryrwa.com -

LRWA Membership/Renewal Application

(Please print clearly)

Date: _____________­­­­____

Name:
__________________________________________________________

Mailing Address:
__________________________________________________________

City:
__________________________________________________________

State/Province:
__________________________________________________________

Zip/PC:
__________________________________________________________

Country:
__________________________________________________________

Phone
(days): _______________________ (eves): ________________________

Fax:
__________________________________________________________

Email:
__________________________________________________________

Website:
__________________________________________________________

 

Select one:
○ New Member ○ Renewal

RWA® membership number (Required for LRWA membership):
__________________________________________________________

Pseudonym(s):
__________________________________________________________

I joined LRWA because: (Check all that apply)
○ No local chapters nearby.
○ Recommended by LRWA member.
○ I am interested in services provided.
○ Visited the web site.
Other:
__________________________________________________________

Referred by:
__________________________________________________________

Are you published? ○ Yes ○ No

Are you RWA PRO®? ○ Yes ○ No
○ Book-length Romance
○ Conventional or E-published/Audio
○ Novella or short-story romance
Other:
__________________________________________________________

Are you a member of PAN (RWA® Published Author’s Network) ○ Yes or ○ No

How long have you belonged to RWA®?
_________________ LRWA? ________________

LRWA is operated entirely by volunteers. As we add new programs and services, we need more people to help out. Would you be willing to add your name to our list of those who are willing to assist? ○ Yes ○ No

Sign me up!

My $30.00 membership fee for Lowcountry Romance Writers RWA is enclosed. (Check or money order in U. S. FUNDS ONLY.) There is a $35 charge for returned unpaid checks.
Dues and other amounts paid to the Lowcountry RWA Chapter are not deductible as a charitable contributions, but may qualify as business expenses.
Applications take 4-6 weeks to process. Thank you for your patience.

Signed:
__________________________________________________________

Date: _____________­­­­____

Mail application form and check or money order made out to LRWA to:

Lowcountry RWA
c/o Carla Smith
P.O. Box 718
Summerville, SC 29484

Copyright © 2012 Low Country RWA. All rights reserved.