MEMBERSHIP APPLICATION

The Detroit Writer’s Guild
18600 Conant Avenue

 Detroit, MI 48234

Name: ___________________________________________

Address: _________________________________________

________________________________________

City __________________ State ______  Zip______

Tel: (Home) _____________________

        (Cell) _______________________

        (Work)_____________________

E-Mail ______________________________________

MEMBERSHIP DONATION LEVELS:

 

 

 

Regular Member               _____ ($50)

 

Student/Senior Citizen   _____    ($25)


Patron                                 _____    ($100-$200)

 

Silver Patron                      _____           ($200 - $400)

  

Golden Patron                      _____       ($500+)

     

 

State Your Interests: Poetry _____ Short Stories ______ Novels_____ Non-Fiction ___ Self-Publication ____

                                      Learning Computers ____  Song Writing ________

 

Professional Status: Author ____ Poet ____ Agent _____ Publisher ____ Journalist ___ Musician ____

       Creative Writing Instructor _____  Other ______________________
 

Education: GED _____ High School_____ College (yrs)_____
 

Talents & Special Skills: (Do You know anything about the following fields and are willing to share your time & knowledge with the Guild)

      Art _____ Music _____ Dance _____ Graphics ______ Type Setting ____ Word Processing _______

Photography _______ Editing _______ Proof Reading ________ Book keeping _______ Teaching ____

         Sales & Marketing _____  Creative Writing _____ Publicity/Fund Raising ____  Other______________
 

If You Are A Published Author, List Titles: _____________________________________________________________________________________

 

_____________________________________________________________________________________

 

Signature: ________________________________________

Make Check or Money Order payable to The Detroit Black Writer’s Guild and mail to:

The Detroit Writer’s Guild
18600 Conant Avenue
Detroit, MI 48234
 

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