* First Name
* Last Name
* Address 1
Address 2
* City
* State
* ZIP
* Phone
* Email
* Birthday
May Yellow Rose RWA list your contact information on our membership roster?
Membership Roster Yes No
On the website? Yes No
Are you published in fiction?
Published Yes No
If published, please list publisher(s), line(s), and genre(s).
Publishing Credits
If pre-published, have you completed a manuscript?
Completed Manuscript Yes No
What line(s), genre(s) are you targeting?
RWA membership is required before joining.
* RWA membership #
What would you like most from this organization?
Would you be interested in volunteering? Yes No
Would you be interested in joining an e-mail loop? Yes No
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