Printable application form

PSWA logo final--300Public Safety Writers Association

Application for Membership

 

 

Type of Membership Requested (check one):

Writer Membership—One Year $55.00
Writer Membership—Two Years $$100.00
Writer Membership—Three Years  $135.00
Corporate Sponsor–$250.00 per year. Includes all “Writer Membership” benefits plus a listing in each quarterly issue of The Public Safety Writer newsletter.
Membership Name:  
Pseudonym (if any):
Mailing Address:  
City, State, Zip  
Preferred phone:  
Other Phone:  
Email address:  
How did you hear about us?  
Previously published works, if any (use a separate sheet if needed):

 

 

 

 

A short biography, including your public safety affiliation (use a separate sheet if desired):

 

 

 

 

 

Payment: enclose check, money order or purchase order payable to Public Safety Writers Association.

Return this completed application to:  

Public Safety Writers Association
P.O. Box 482
Ventura CA 93007