Membership Application

Complete and print this form. Mail it with your check to:

Berkeley Branch, California Writers Club
c/o Evelyn Washington
P.O. Box 15014
Oakland, CA 94614

All fields are required.     Trouble printing? Try this version.
Date of Registration: 
Name: 
Address: 
City:
State:   
Zip Code:  
EMail:    
Phone:
I am applying for
(select  one):  		Active (published) membership
Associate (non-published) membership
I enclose for consideration
(select one): 		a clip of a published work (for Active membership)
a writing sample (for Associate membership)
I write in the following area(s)
(check all that apply): 		Novel    Short Story Poetry
Non-Fiction  Book  Non-fiction article
Journalism  Editing
Screenplay  Script  Play production
Other: 
I enclose a check or money order payable to CWC Berkeley for:

$65 Full-Year (Year begins July 1 )

$42.50 Half-year (Jan. 1 to June 30)

$30 Youth Membership

Note: All first-year dues include a $20 one-time processing fee.

Signature of Applicant __________________________       Date: ___________