West Virginia
                      Writers 
APPLICATION FOR MEMBERSHIP
2016-2017
(Printable Version)


NAME                                                                                         

ADDRESS
                                                                                   

CITY
                                                                                            

STATE
               ZIP                   

COUNTY
                                                                                    

PHONE                                                                                       

E-MAIL ADDRESS                                                                   

REFERRED BY                                                                         

WRITING INTERESTS                                                            

                                                                                                     

MEMBERSHIP TYPE                                                               

(A) Adult Membership - $20 per year
(S) Student Membership - $10 per year
(Y) Youth Membership (under 18 years of age) $5 per year

Due annually on July 1

____ I wish to receive my newsletter exclusively online.

MAIL CHECK AND APPLICATION TO:

WEST VIRGINIA WRITERS, INC.

c/o Grace Pritt
138 Hidden Valley Estates

Scott Depot, WV 25560