EmailMe Form - NTRW Membership Application

Membership Status: *
New Member
Renewing Member
Name for NTRW Roster: *
First Last
Pen Name if applicable:
First Last
Contact Email: *
This is the chapter's primary method of communication.
Include on Roster *
Yes
No
Check yes or no to be listed (or not) on our membership roster (name, pen name, and email). Our roster is available only to current NTRW members.
Membership Roster
* * * * *
Information you supply in this section will be included on our master membership roster which is accessible to board members only.
Birthdate:
MM / DD / YYYY
We don't require the year of your birth. Please just put 1900 in the year field.
Phone:
### - ### - ####
Mailing Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

P.O. boxes are fine.
SOCIAL MEDIA
NTRW wants to connect with you. Please use complete URLS.
Website
Blog
Facebook
Facebook Fan Page
Twitter
Amazon Author Page
Goodreads
Pinterest
Instagram
YouTube Channel
Writing Experience
Writing Experience
Working on first manuscript.
Finished manuscript(s), not yet published.
Published in romance.
Published in other genres.
NYT Bestseller
USA Today Bestseller
PW Bestseller
Genre/s writing in...
Genre/s published in...
Organization Administration
The following information is needed for NTRW
admin purposes; any info provided will not be incliuded on rosters.
Please select if you'll allow us to...
Use your image on our website.
Use your image on NT social media.
Add you to our email newsletter list.
Invite you to our discussion loop at Groups.io.
None of the above.
Email for Groups.io Discussion Loop Invite
if different than contact email
Newsletter
Email
if different than contact email
Dues are $35 per year.
Your membership is on annual basis, good for one year from the time of dues payment.
To pay (via Paypal), go here:
https://www.ntrw.org/membership-payment-portal

* * * * *
A PayPal account isn't necessary as long as you have a debit or credit card to use.
Email used for
PayPal payment
PayPal Transaction ID: *
Membership isn't official until dues are paid. Please make your payment and enter your PayPal Transaction ID or confirmation number here.
Yes--I agree: *
Yes, I agree
I agree to hold harmless the North Texas Romance Writers board, the individuals who serve on the board, as well as the venue at which meetings are held from all claims or liabilities of any kind arising out of my participation in any chapter activities, even though that liability may arise out of negligence or carelessness on the part of the persons named in this waiver.
Signature: *
Please type your legal name. Receipt of electronic copy verifies/constitutes your signature of this application.

Membership Roster * * * * *

SOCIAL MEDIA

Writing Experience

Organization Administration

Dues are $35 per year.

To pay (via Paypal), go here:

Membership Roster
* * * * *