MARSHLANDS ROMANCE WRITERS

Membership Application

(Please feel free to print out this application for mailing.)

Name: ____________________________________________________________
(First, Middle, Last)

Address: _____________________________________________________________________________
(Street, City, Province, Postal Code)

Home Phone: _______________________

Work Phone: _______________________

E-mail: __________________________

Fax: ____________________________

RWA #__________________

MRW Fees: Annual Membership Fee 20.00
(Due upon joining with renewal due by January 31 of each year thereafter)

Signature:_________________________________________________

Date:____________________________

Make cheques or money orders payable to: Marshlands Romance Writers

Please send your payment and membership application to:

Marshlands Romance Writers
46 Liberty Cres
Moncton, NB E1A 6H3
CANADA