http:/www.berkeleywritersclub.org

Application for Membership in the CWC Berkeley Branch

Name ____________________________________________________

Phone ____________________ Email ___________________________

Address ___________________________________________________

City _______________________________ State ______ Zip _________

(Choose one) I am published (Active membership) ___
I have works in progress (Associate membership) ___
I am applying for Supporting ___ or Youth membership ___

(Choose one writing area) Novel ___ Short Story ___ Poetry ___
Journalism ___ Nonfiction book ___ Nonfiction article ___
Script ___ Play ___ Editing ___ Other _________________

Signature _________________________________ Date __________

(Please submit publications list for Active membership, or sample of
writing for Associate membership, along with a dues check filled out to CWC, Berkeley Branch)

Initiation fee $20; Annual dues, $45 ($10 for Youth)

Check enclosed: full year ($65, or $30 for Youth) ___________

Or half year $42.50 (Jan. 1 to June 30) ____________

Endorsed as Active by ______________________________________

Endorsed as Associate by ___________________________________