Member Name
first*: middle: last*:

Pen Name
first: middle: last:

Do you wish to be listed under your legal name or your pen name on our webpage?: Legal Name   Pen Name

Do you wish to have your legal name or your pen name used for postal mail? (used only for renewal notices and checks from book table sales): Legal Name   Pen Name

Address One*

Address Two

City*   State/Province*

Postal Code*   Country

Telephone   Email*

Web Site URL

Biography:
Please limit to about 50 words (or what fits in this box) -- longer entries may be truncated.

May we use your name in our publicity materials?*: Yes   No

Membership Type*: New member   Renewal   Gift
Donor's Email (for gift)

Membership Status*: Level One ($30)   Level Two ($15)

If you have not used PayPal before, you will be prompted to set up an account. There is no charge to create a PayPal account, but you will have to enter a credit card number on their secure server. If you want to use a credit card without setting up a PayPal account, you can do so via PayPal as well.