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Thursday, 17 of May of 2012

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ESPAN RWA Membership Application

Please fill out the form below in order to apply for membership with ESPAN RWA
(Electronic and Small Press Authors’ Network, RWA Special Interest Chapter #200)

Membership Type:  General Membership Associate Membership

Your Real Name:

Your Email:

Street Address:
City: , State/Prov:
Zip/Postal Code: Country:
*NB: The above is all required information

Phone # (for office use only)
Home (required): Work:

Website URL:

National RWA Member # (required):

Published?  Yes No Fiction Non-Fiction Romance Other

Pen name/Psuedonym(s):

Publisher(s):

General Member Dues $20 if joining 10/1 to 3/31 or $10 if joining after 4/1 but before 9/30

Associate Member Dues $15 if joining 10/1 to 3/31 or $7.50 if joining after 4/1 but before 9/30

* If you haven’t already paid the Paypal payment link can be found HERE on the ‘Join Us Page’

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