Midwest Fiction Writers Membership Form

You must be a member of Romance Writers of America (RWA) to be a member of MFW. Dues of $35 for 2012 are due by March 1. Late renewals (emailed, postmarked or hand-delivered after March 1) pay a $5 late fee ($40 total). New members (not in the last two years) pay a $5 one-time fee ($40 total for first year). New members joining after July 1 pay $20 for the second half of the year plus the $5 one-time fee ($25 total). All information is required for the MFW board’s records. Each year we publish a roster for the chapter members.

Please check for any information you wish left OFF the official roster.

Complete this form and send with a check (in US funds only) payable to Midwest Fiction Writers to:

Midwest Fiction Writers

2012 Membership

P O Box 24107

Minneapolis, MN 55424

RWA®# _______________

I am RENEWING my MFW membership I am a NEW MFW member

($35 until March 1, then $40) ($40 until June 30, $25 beginning July 1)

Name: __________________________________ Pen Name: ____________________________

Address _______________________________________________________________________

City ____________________________________ State ___________ Zip Code ______________

Home Phone: ____________________________ Work Phone: ___________________________

E-Mail Address: __________________________________________________________________

 Please check if you DO NOT want your contact information published in the Membership Roster.

Please check all that apply:

Pan Member ___________ Published Author ___________ PRO member ______________

 Please check if you would like your website and/or blog added to the MFW website Members Link

If so, please provide website and/or blog addresses. You may list more than one.

Website Address ______________________________________________________________________

________________________________________________________________________

Blog Address _________________________________________________________________________

________________________________________________________________________