Membership Form

   Lilac City Rochester Writers  

NAME ______________________________________________________________________________

PSEUDONYM(S) _______________________________________________________________________________________

ADDRESS __________________________________________________________________________

__________________________________________________________________________

PHONE (home) ______________________________________________

  (cell) ______________________________________________________

E-MAIL _______________________________________________  (If there is any doubt about a meeting being canceled, please check your email before you leave home.)

What do you hope to gain from joining LCRW?__________________________________________________________________________

__________________________________________________________________________

What genre(s) do you write?  __________________________________________________________________________

What genre(s) do you read?  __________________________________________________________________________

Dues are $20.00 per year.

You can print this page and mail your dues to the following address or hand them in at the next monthly meeting.