NEW MEMBER APPLICATION

Date: ____________________
Name: ______________________________________________
Address: ____________________________________________
City: ___________________________State/Zip _____________
Phone: ____________________ Alt. Phone ________________
Email: _____________________Alt. email __________________

Note: Our membership year is from July 1 through June 30. Application fees are discounted effective January 1st. See back page for fees.
Questions should be sent to the membership chair, cwcsanfernandovalley@gmail.com.

Membership Status applied for: 
(See website cwc-sfv.org for details)

¨    Active: 

I certify that I have had:
(1) a book published by a publisher of standing within the last ten years, or
(2) a book currently under contract, or
(3) a publication or acceptance within the past three years of not fewer than three stories, articles or columns in a periodical or periodicals of general circulation, or (4) a publication, performance, production or production in development within the past ten years of a stage play, screenplay, radio play, television play, or video.
(4) You may include a list of blogs or on-line writing and sites in addition to your sample.

¨      Associate: 

Submit a sample of your writing along with this application
for the branch accreditation committee review.
(1) One sample no longer than 2500 words
(2) Double spaced
(3) Word Times New Roman 12 pt font
(4) You may include a list of blogs or on-line writing and sites in addition
to your sample.

¨     Dual:

I am presently an active member of the following CWC
branch(es):
_______________________________________________________________________

Please list your genre (s) and areas of interest.
__________________________________________________________________________________
__________________________________________________________________________________

Please make check out to: CWC-SFV.
$65.00 New member (Application submitted July 1 – December 30)
$42.50 New member (Application submitted January 1 – June 30)
$25.00 New member to SFV, already a member at another CWC branch
$675.00 Lifetime membership (Active status members only)
$45.00 Membership renewal fee due July 1 – mid-September. Date TBA.

RETURN APPLICATION, WRITING SAMPLE AND CHECK TO
P.O. Box 564
21200 OXNARD ST
WOODLAND HILLS, CA 91367-9998

Or if you pay online, send your completed form and writing sample to:
cwcsanfernadovalley@gmail.com