MEMBERSHIP APPLICATION FORM

Please refer to the Membership Requirements menu item for any questions about elgibility requirements.


Date:
Name:
Address(90 character Limit)
Phone
Fax
Email
Brief Bio(400 character Limit):
Comments(400 character Limit):


Book1:Genre
Sold to(160 character Limit):

Date Sold:
Date Published:
Amount Paid:
ISBN:


Book2:Genre
Sold to(160 character Limit):

Date Sold:
Date Published:
Amount Paid:
ISBN:


Book3:Genre
Sold to(160 character Limit):

Date Sold:
Date Published:
Amount Paid:
ISBN:

You will be contacted once your application has been decided.
If it is approved, you may submit the appropriate membership dues
by check or money order
payable to Missouri Writers' Guild
to Steve Wiegenstein, Treasurer
4700 Roemer Rd.
Columbia, Mo. 65202
Or via PayPal
in order to make your membership official.