MEMBERSHIP APPLICATION

DATE _________________________ CHAPTER ____________________________________

NAME _______________________________________ TITLE __________________________

COMPANY ___________________________________________________________________

ADDRESS ____________________________________________________________________

CITY ____________________________________ STATE ______ ZIP _________________

BUS. PHONE (____)____________________ HOME PHONE (____)_____________________

FAX PHONE (____)____________________ E-MAIL _______________________________

Do not list home phone home address on Web site in Member Directory

Information on yourself and/or company:
____________________________________________________________________________________
_____________________________________________________________________________________
_________________________________________________________________

Title(s) of book(s) you have authored and/or published:
______________________________________________________________________________
______________________________________________________________________________

Note: The above will appear in our directory and on our Web site. Please limit to 40 words.

List works in which you have been involved and state whether you were the author, editor, illustrator, graphic designer, publisher, etc.
______________________________________________

_________________________________________________________________________
_________________

If you are not involved in publishing, please state your major areas of interest.
______________________________________________________________________________

What type of seminar/workshop would you be interested in attending or presenting?

Attending: ____________________________________________________________________

Presenting: ____________________________________________________________________

Would you be interested in writing articles for the newsletter? Yes No

If so, contact Senior Editor of SPAWNews at 818-886-4281; e-mail editor@spawn.org.

How did you hear about us? _______________________________________________________

SPAWN membership dues are $45 per year. Members’ spouses and business partners at same address may join for only $22.50. Complete a separate application for each member.

Enclosed is $__________ for ______ member(s)

Please send the completed application and a check for dues to SPAWN

Small Publishers, Artists & Writers Network
PMB 123
323 E. Matilija St., Suite 110
Ojai, CA 93023
Telephone 818-886-4281
Fax: 818-886-3320