squaretest Membership Registration/Renewal (1) Date MM slash DD slash YYYY Name* First Last I will be paying* Online By Mail Annual Membership Dues* If you join Jan-Mar If you join April-June If you join July-Sept If you join Oct-Dec. 31* Student Membership Annual fee billed each calendar year and pro-rated quarterly for new members who join throughout the year. *Members who sign up Oct. 1-Dec. 31st membership will extend through the next calendar year. Payment InformationTotal $0.00 Total Fee being Mailed inSouthern California Writers Association P.O Box 47 Huntington Beach, CA 92648 $0.00 Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Phone type* Mobile Landline Work About your writing:I write or would like to write:Non-fiction: Select All Feature articles Essays/OpEd For the web Non-fiction books Technical Trade articles Biographies/Memoirs Copywriting/PR Writing Travel/Outdoors/Nature Social Issues Fiction: Select All Short Stories Literary Romance Mystery Thriller Science Fiction Fantasy Horror Religious Children's Historical Fiction Screen/Stage: Select All Theatre Film Television Religious Children's Poetry: Select All poetry I am a publishing professional: Editor Agent Publisher Other
