ROMANCE WRITERS OF AMERICA, MISSOURI CHAPTER (MORWA)
MEMBERSHIP APPLICATION

NOTE: You must be a member of National RWA to join MORWA.

* Indicates required fields.

*RWA National Membership #:
*First Name:
*Last Name:
Name (such as pseudonym) to "known" by in the chapter:  ** This is the name that will be used on your name tag, in the membership directory, and other chapter materials.
*Street Address:
*City:
*State:
*Zip:
*Home Phone:
ex: (xxx)123-4567
Best Time To Call:
Cell Phone:
ex: (xxx)123-4567
Birthday:
(Month/Day Only)
 
*Email Address:
Website:

Check all that apply:   Published, romantic fiction   Published, Other
  Unpublished   Editor
  Press   Media Representative
  Bookseller   Agent

  Other    


If Published, please list pseudonyms and Publishers:


Yes, I'm willing to act as a resource for other members in the following areas of expertise.  I understand that this information will be printed in the Membership Directory. 

(Example: Army Officer, alpaca farming, minor league baseball)


*My personal information may be printed in the Membership Directory:

Yes   No

*Occasionally MORWA has the opportunity to use videos, photos and names of our members in our publicity efforts, such as on our website, during a media event, or other activities.  We need your permission to use your name and/or picture in these efforts. 

Please select one of the following options for publishing photos:  

   I authorize Missouri Romance Writers of America to publish the photographs taken of me, and my name, for use in the MORWA printed publications, website, and other forms of internet based publications. I acknowledge that since my participation in publications and websites produced by MORWA is voluntary, I will receive no financial compensation. I further agree that my participation in any publication and website produced by MORWA confers upon me no rights of ownership whatsoever. I release MORWA from liability for any claims by me or third party in connection with my participation.

  I authorize on a limited basis Missouri Romance Writers of America to publish the photographs taken of me, and my name, for use in the MORWA printed publications, website, and other forms of internet based publications.  Such events include: business meetings, award ceremonies, book signings, and other official professional MORWA events. I acknowledge that since my participation in publications and websites produced by MORWA is voluntary, I will receive no financial compensation. I further agree that my participation in any publication and website produced by MORWA confers upon me no rights of ownership whatsoever. I release MORWA from liability for any claims by me or third party in connection with my participation.

  I do not authorize Missouri Romance Writers of America to publish the photographs taken of me for use in the MORWA printed publications, website, and other forms of internet based publications.

Please select one of the following options for publishing videos:  

   I authorize Missouri Romance Writers of America to publish videos taken of me, and my name, for use in the MORWA printed publications, website, and other forms of internet based publications. I acknowledge that since my participation in publications and websites produced by MORWA is voluntary, I will receive no financial compensation. I further agree that my participation in any publication and website produced by MORWA confers upon me no rights of ownership whatsoever. I release MORWA from liability for any claims by me or third party in connection with my participation.

  I authorize on a limited basis Missouri Romance Writers of America to publish videos taken of me, and my name, for use in the MORWA printed publications, website, and other forms of internet based publications.  Such events include: business meetings, award ceremonies, book signings, and other official professional MORWA events. I acknowledge that since my participation in publications and websites produced by MORWA is voluntary, I will receive no financial compensation. I further agree that my participation in any publication and website produced by MORWA confers upon me no rights of ownership whatsoever. I release MORWA from liability for any claims by me or third party in connection with my participation.

  I do not authorize Missouri Romance Writers of America to publish videos taken of me for use in the MORWA printed publications, website, and other forms of internet based publications.

 


Please rank two or three committees you'd be willing to serve on.
(Note: MORWA Bylaws require everyone to serve on at least one committee (Art. V.A.1.a))
  Contest Committee
  Chapter Programs
  Special Events
  Other
    (If other, please specify) 
  Newsletter
  Publicity

    *I verify the information provided on this form is true as of this submission and that checking this box constitutes my formal agreement to become a member of the Missouri Romance Writers of America.


*Dues:   $25 new membership
    $15 new membership, if joining after June 30, 2016
    $25 membership renewal, due January 31, 2016
    $30 membership renewal, if renewing after January 31, 2016

*How will you be paying?
(You will be provided with
Paypal links and a mailing address for checks/money orders on the next page. )
Check or Money Order sent via mail
Check or Money Order delivered at the next meeting
  Paypal 
If you would like to donate to the MORWA Hope Fund, used to sponsor MORWA memberships to writers undergoing temporary financial hardship, simply include your donation on your check/money order.  If you choose to pay your membership fee via Paypal, an opportunity to donate via Paypal will be presented after you complete your membership payment.

Submitting this form will send the information to the MORWA Membership Committee and chapter Treasurer. 

Please submit this form only once.  You will receive a verification copy of this form at the email specified above.