Application
Form
Charter Oak Romance Writers Inc.
Please complete
the information below and send it along with a check or money
order for $20 Membership Dues to:
Membership
Chair
CORW
PO Box 331002
West Hartford, CT 06133-1002
Membership
Dues payment can be made at https://www.paypal.com/ with
CORWtreasurer2@gmail.com as recipient.
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| First
Name |
_____________________________ |
| Last
Name |
_____________________________ |
| Address1 |
_____________________________ |
| Address2 |
_____________________________ |
| City |
_____________________________ |
| State |
_____________________________ |
| Zip |
_____________________________ |
| Email |
_____________________________ |
| Phone |
_____________________________ |
| RWA
Number |
_____________________________ |
| Received
Newcomer Packet? |
Yes_____
No_____ |
| Are
You Published? |
Yes____ Not
yet_____
Genre________________ |
| Referred
By |
____________________________________ |
| Your
Signature |
____________________________________ |
|
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