Utah RWA Membership Application Form

Romance Writers of America® UTAH/Salt Lake Chapter # 61
Membership Application

To apply for UTAH/Salt Lake Romance Writer Chapter # 61 membership, you must be a member of National Romance Writers of America® or you must join immediately following your membership in the UTAH/Salt Lake Romance Writer Chapter # 61.

Click here to access RWA webiste for National RWA application.

Chapter dues are $36 annually, due by December 31.

If you are RENEWING your membership at any point during the year, your dues are $36.

NEW MEMBEMBER dues are prorated to the month you join. Please follow the schedule below for the amount you need to pay.

Joining URWA in:	Please pay:
January	$36
February	$33
March	$30
April	$27
May	$24
June	$21
July	$18
August	$15
September	$12
October	$9
November	$6
December	$3

Paying via PayPal: Click here to pay dues using PayPal.

Paying via Check: Please print and complete manual application and mail to:
Utah Chapter of Romance Writers
c/o Membership Dues
P.O.Box 522365
Salt Lake City, Utah 84152-2365

All information contained herein is confidential.

Date:

NewRenewal

Member Name:

RWA Membership Number:

If published, list Pseudonym:

Address(Str/City/St/Zip):

Preferred Phone:

Other Phone:

Email Address:

WebSite Address

Birthday (optional):

Do you wish to have this information published in the member directory? YesNo

May we use your photo on our website? YesNo

If published, list Credits/Publishing House(s):

Please check all that apply:

Published Author: Book Length Romance

Published Author: Other

Unpublished Author

RWA PRO

RWA PAN

Editor

Bookseller

Press Rep

List other professional memberships:

What do you wish to obtain from membership in UTAH/Salt Lake Chapter RWA®

List special interests/areas of expertise:

List any areas you would be willing to volunteer (newsletter, publicity, membership, contests, conference committees, etc.):

Pay using PayPal