First Coast Romance Writers
Membership Application

Please print clearly or type:

Name: ____________________________________________________________________

Address: _________________________________________________________________

City: ______________________________________ ST: ______ Zip: _____________

Home Phone: (_____)___________________ Work Phone: (_____)________________

Fax Number: (_____)______________________

Email: _______________________________________________________

Birthday (year optional) __________________

You must be a member of Romance Writers of America to join FCRW.
You can submit both applications simultaneously.

National RWA Number: _____________________  Joining RWA: ____________

Published: ____ No ____Yes

If published please attach a list of your publishing credits.

Genre(s): ________________________________________________________________

Pseudonym(s)______________________________________________________________ 

Name to be used on badge: ________________________________________________

Membership dues - $20.00 (July 1st to June 30th)

Please return this completed form and check for the correct amount, 
made out to FCRW to: 

Membership Chair
P.O. Box 32465
Jacksonville, FL 32237-04654 

For FCRW use only: 
Date Received ____________ Amount Received ________ Cash ___ Check # _____

RWA Number Verified ______ Yes _______ No

FCRW ID # _________

Member Information Sheet

Name: ____________________________________________________________________

How long have you been writing? __________________________________________

Have you submitted anything for publication? _____________________________

Hobbies: _________________________________________________________________

__________________________________________________________________________


Do you have any special expertise you would be willing to share with the 
chapter for instructional research purposes? 

___________________________________________________________________________ 

___________________________________________________________________________

Before joining FCRW, did you belong to any other Chapters of RWA or writing 
organizations? _______ 

If so, please list them: __________________________________________________

____________________________________________________________________________

What type of Romance or form of other fiction are you writing or plan to write? 

___________________________________________________________________________

___________________________________________________________________________

Are you willing to volunteer time to help out at chapter events? __________

How did you learn about FCRW? _____________________________________________

___________________________________________________________________________

What do you expect to achieve from being a member of FCRW? ________________

___________________________________________________________________________

___________________________________________________________________________

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