New & Renewal Membership Application to
Wisconsin Regional Writers Association, Inc.

_____I want to become a member. _____I want to renew my membership.

_____I do NOT want my name shared with other writing resources.

I have enclosed: $__________for___year(s) Regular adult WRWA membership.
                                                                         ($25.00 for one year.)
I have enclosed: $__________for___year(s) Student WRWA membership.
                                                                         ($12.50 for one year.full-time high school or college, age 23 or under)
I have enclosed: $__________for___year(s) Family two-person WRWA membership.
                                                                         ($35.00 for one year.)
(Financially-assisted memberships may be arranged by confidential request to the membership registrar, Robin Butler)

Name: ____________________________________________________

Address: __________________________________________________

City_______________________________ State__________________

Zipcode__________________-_______

Telephone (_____)_________________

Email ___________________________

Did a WRWA member encourage you to join? Yes_____No_____

If so, who? ___________________________________________

Do you belong to a writers' group? Yes_____No_____

If yes, what group? _____________________________________

If no, would you like information on a club near you? Yes____No____

Make checks payable to: WRWA, Inc.

Mail to:

Robin E. Butler
Membership Chair
1408 Columbus Street
Manitowoc WI 54220-5602

(920) 682-1795