New Gift Membership New Gift Membership Registration Date MM slash DD slash YYYY Name* First Last Referring SCWA member* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Phone type* Mobile Landline Work About your writing:I write or would like to write:Non-fiction: Select All Feature articles Essays/OpEd For the web Non-fiction books Technical Trade articles Biographies/Memoirs Copywriting/PR Writing Travel/Outdoors/Nature Social Issues Fiction: Select All Short Stories Literary Romance Mystery Thriller Science Fiction Fantasy Horror Religious Children's Historical Fiction Young adult and middle grade Screen/Stage: Select All Theatre Film Television Religious Children's Poetry: Select All poetry I am a publishing professional: Editor Agent Publisher Other
