Florida Star Fiction Writers Membership Form

Please fill in the form below.

(*) Required Field
Legal Name*

First Last
Date

MonthDay Year
Date
Pen Name (if different from Legal Name)

First Last
E-mail*
example@example.com
PayPal Account E-mail (if different from E-mail)
example@example.com
PayPal ID or Business Name (if different from Legal or Pen name)
Phone Number*
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Which of the following applies to you?

UnpublishedIndependently PublishedTraditionally PublishedHybrid Published (Indie & Traditional)
Would you like a lanyard to wear at the FSFW meetings?

YesNo
If yes, what name would you like printed on your lanyard?
Comments/Questions/Anything you'd like us to know about you:
Registration Fees:*

Member Renewal $25New Member Registration $50 (01/01 thru 06/30) or $25 (07/01 thru 12/31)
Calculation
Total Payment Due:

prevnext( X )
USDDescription
Should be Empty:

Please fill in the form below.