49 Writers membership form

49 Writers Membership Form


By joining 49 Writers, you’ll receive special rates on workshops, clinics, classes, and other special events. You’ll also get a 10% discount on rates at our Raven Place guesthouse. And though membership isn’t required to be part of our statewide writing community, we appreciate the commitment you make by joining. Annual memberships starting at $60 are valid until October 1, 2011. Join at the Jade level ($100) or higher before July 1, 2010, and you’ll be a founding member. Thanks much for partnering with us.

Note:  This temporary form is for use while our third-party server is down.  If you'd prefer a form-fill version, email 49writers@gmail.com and ask for the membership form. 

Last name:

First name:

Mailing address:

City:

State:

Zip code:

Email address:

Phone number with area code:

Level of membership:

0 Regular member ($60)

0 Founding member: Jade ($100-$499)

0 Founding member: Copper ($500-$999)

0 Founding member: Gold ($1000-$4999)

0 Founding and Lifetime member: Platinum ($5000 and up)

Which describe you? Choose all that apply:

0 Writer

0 Lover of books

0 Friend of writers

0 Teacher

0 Librarian

0 Publisher

0 Bookseller

(Optional) Your age:

0 under 25 yrs.

0 26-35 yrs.

0 36-45 yrs.

0 46-55 yrs.

0 55-64 yrs.

0 65+ yrs.

We never sell or distribute contact information, but may we publish your name as a member of 49 Writers?

0 Yes

0 No

Your membership activates upon receipt of your membership fee, payable through PayPal (access via 49writers@gmail.com) or by check mailed to 49 Writers, PO Box 221086, Anchorage, AK 99522.