test page for forms Contact Us Name* First Last Email* R.S.V.P. to the February 24 Pub Shop* Member RSVP Nonmember RSVP PaymentTotal $0.00 CAPTCHA "*" indicates required fields Name* First Last Email* R.S.V.P. to the May 17 Meeting* I am a member and will be attending in person I am not a member and will be attending in person Test Would you like to bring a guest?* No I would like to bring a guest who is a member I would like to bring a guest who is not a member If you are paying for a guest, what is their name? First Last If you are paying for a guest, what is their email address? PaymentTotal Payment MethodPayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name CAPTCHANameThis field is for validation purposes and should be left unchanged. "*" indicates required fields Date MM slash DD slash YYYY Name* First Last Membership type* New membership Renewal I will be paying* Online By Mail Total Annual membership dues if you join anytime:*April-JuneTotal Being Mailed InSouthern California Writers Association P.O Box 47 Huntington Beach, CA 92648 Email* 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 Phone*Phone type* Mobile Landline Work Other About your writing:I write or would like to write:Fiction: Short Stories Literary Romance Mystery Thriller Science Fiction Fantasy Horror Religious Children's Historical Fiction Young adult and middle grade Select AllNon-fiction: Feature articles Essays/OpEd For the web Non-fiction books Technical Trade articles Biographies/Memoirs Copywriting/PR Writing Travel/Outdoors/Nature Social Issues Select AllScreen/Stage: Theatre Film Television Religious Children's Select AllPoetry: poetry Select AllI am a publishing professional: Editor Agent Publisher Other Payment Method*PayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name CAPTCHAPhoneThis field is for validation purposes and should be left unchanged. Email(Required) Your Message Member Name* First Middle Last Suffix Upload Member Profile Picture*Accepted file types: jpg, png, pdf, Max. file size: 2 MB.jpg, png, pdf (approx max/min size 5x7 at 72dpi)Book Cover(s) Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 5 MB. jpg, png, pdf (approx max/min size 5x7 at 72dpi)About Bio* "*" indicates required fields Date MM slash DD slash YYYY Name* First Last Membership type* New membership Renewal I will be paying* Online By Mail Total Annual membership dues if you join anytime:*April-JuneTotal Being Mailed InSouthern California Writers Association P.O Box 47 Huntington Beach, CA 92648 Email* 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 Phone*Phone type* Mobile Landline Work Other About your writing:I write or would like to write:Fiction: Short Stories Literary Romance Mystery Thriller Science Fiction Fantasy Horror Religious Children's Historical Fiction Young adult and middle grade Select AllNon-fiction: Feature articles Essays/OpEd For the web Non-fiction books Technical Trade articles Biographies/Memoirs Copywriting/PR Writing Travel/Outdoors/Nature Social Issues Select AllScreen/Stage: Theatre Film Television Religious Children's Select AllPoetry: poetry Select AllI am a publishing professional: Editor Agent Publisher Other Payment Method*PayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name CAPTCHANameThis field is for validation purposes and should be left unchanged.
