Florida Star Fiction Writers Membership Form

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Legal Name *

First Last
Date

Month Day Year
Date
Pen Name (if different from Legal Name)

First Last
E-mail *
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Phone Number *
Address *

Street Address

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Which of the following applies to you?

Unpublished Independently Published Traditionally Published Hybrid Published (Indie & Traditional)
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Member Renewal $25 New Member Registration $40 (01/01 thru 06/30) or $20 (07/01 thru 12/31)
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