CRW Application

Chesapeake Romance Writers Membership
Application

Date:
Please complete in full.  The information you provide us will
be used for the development of programs, forums, editor visits, and many

other activities.
Name:____________________________________________________________________________

Pseudonym(s):______________________________________________________________________

Address:
Street ________________________________________________________________
City___________________________________
State___________________________
Zip___________________
Phone: Home______________  Work__________________ Email Address______________________
Would you be willing to be a speaker at a CRW meeting?  (Circle One)   YES  NO
Published? (Circle One)   YES  NO
If yes, Name of Publisher(s)_____________________________
If published, please list genre and titles on the back of this form.

What do you write?  (Check One)
_____Romance _____Mystery---_____SF/Fantasy_____Horror_____Non-Fiction_____Other_______
Current target house(s) and line(s):________________________________________________________
Do you want us to help find you a critique partner?  (Circle One) YES  NO
Would you like to be added to CRW's chapter critique list?  YES NO
Do you have a web page?  YES  NO    If so,
would you like a link added to CRW's Website?  YES  NO
Day/Month, and place of birth:___________________________________________________________

The following information to for our data base:
Other cities, states, or countries where you have resided:_______________________________________
Education:____________________________________________________________________________
Current employment:___________________________________________________________________
Hobbies/Interests/areas of special knowledge or expertise:_______________________________________
If a CRW member needed information you list here can they contact you?  YES  NO
Other clubs, writers, or professional organizations you belong to:__________________________________

Annual dues are $30.00.  Membership is renewed each year in the month you joined.  A late fee of $5.00 will be added for dues paid later than 60 days from the due date.  You MUST become a member of the Romance Writers of America within three months of becoming a CRW member.  An RWA membership form is included in this packet.

To join CRW, please complete this form and attach the dues, payable to the Chesapeake Romance Writers, RWA Chapter #111.  Mail both to Chesapeake Romance Writers, C/O 

Susan Anthony, PO Box 9391, Chesapeake, VA  23321 .  If you have any questions contact Susan at santhonyromance@yahoo.com