NCPS Membership Application

Please type or print clearly:                     Date _______________________________

Name________________________________________   Phone (        )____________

Address_______________________________________________________________

City_____________________________   State______________   Zip______________

Email Address __________________________________________________________

Membership Type   (check one):
Regular (Annual Dues $25) _____    Student (Annual Dues $10) _____    Lifetime ($400) _____

Please include a check for the appropriate membership, made out to NCPS, along with this application and a biographical sketch of about 35 words for our newsletter.

Are you a new member?   (please circle):   YES   or   NO
Each new member may choose to receive a critique of three poems. If you wish the critique, please send three copies of each poem and two SASEs along with this application.
 

YOU CAN HELP!
Please let us know if you would like to serve on a committee by specifying one of the following:    Workshops
      Book Sales     Membership     Other: _____________