GothRom Membership Application

Gothic Romance Writers
c/o Karen McCullough
PO Box 10633
Greensboro, NC 27404

GOTHROM ACCEPTS MEMBERSHIP DUES VIA PAYPAL (you still need to send a membership application, either to the above address or online).
(Click on the Paypal logo below, and make sure to specify "New Member Dues.")

_____ ENCLOSED $20 Annual Dues  (June 1 to Nov. 30)  

 ____ $20 Dues Via Paypal (June 1 to Nov. 30)

_____ ENCLOSED $10 Annual Dues  (Dec. 1 to May 31)     

 ____ $10 Dues Via Paypal  (Dec. 1 to May 31)

NAME________________________________________________________________

RWA Membership # _______________ (Must be an RWA member)

ADDRESS____________________________________________________________

CITY_____________________ STATE______________ZIP______________

PHONE ___________________________ FAX __________________________

E-MAIL (please print CLEARLY)_____________________________________________

URL of your home page _________________________________________________

May we list your name, homepage and e-mail on our website roster?
Yes No

Has your work been published?
Yes        No

If you use pseudonym(s) please list below.

Do you have special interests or knowledge to share with members?
Yes        No

If you answered Yes to the above questions please list your special interests.

Would you write an article for the newsletter about it/them?
Yes                     No                    Maybe

Would you be willing to serve as an officer of this chapter?
Yes                   No                     Maybe

If yes, do you have a preference of office?

Would you like to volunteer to be on a chapter committee?
Yes                    No                     Maybe

If yes, do you have a preference for which committee?

Would you serve as a Contest Judge in a chapter Contest?
Yes                     No                     Maybe

Your Comments:

Signature ________________________________

Date _______________________