Add New Constituent

Last Name

First Name

Address
City	State	Zip	County (NC)	County (Not NC)
Country
Address 2
City 2	State 2	Zip 2

Organization	Title
Email	Spouse/Other

Home Phone(ext, note ...)		Office Phone(ext, note ...)
Cell Phone(ext, note ...)		Fax(ext, note ...)
Member Since	Expiration Date:	Co-member's Name

Writing Genres

Novel
ShortStory
Mystery
Romance
Horror

Scifi
Essay
Journalism
Memoir
Biography

Travel
Academic
Plays
Screenplays
Children

Poetry
Business
CreativeNonfiction
Humor
GraphicNovels

Website:

Published Books: Title and Publication Year

Biography

Image File

Programs
CAEHEC
Contestant-DorisBetts
Contestant-RandallJarrell
Contestant-RosePost
Contestant-ThomasWolfe
ContestJudge-Poetry
ContestJudge-Prose
ContestWinner-Poetry
ContestWinner-Prose
Critiquer
CritiquerFormer
FacultyFC
FacultySC
FacultySummer
FacultyWOW
LitHallOfFame
TechClient
Winner-DorisBetts
Winner-RandallJarrell
Winner-RosePost
Winner-ThomasWolfe

NCWN
AdvisoryCouncil
AdvisoryCouncilFormer
Board
BoardFormer
Contractor/Computer
Contractor/Conference
Contractor/Fundraising
Contractor/Graphics
Contractor/MediaRelations
Donor
Intern
NewsletterRecipient
Staff
StaffFormer
Volunteer

Resources
AgentPublicist
AuthorNC
AuthorNotNC
BookIllustrator
BookReviewer
Bookstore
CalendarListings
EditorPublisher
Legislator
Library
LitMagazine
OrganizationArts
OrganizationFunding
PressList
SchoolsK-12
UnivCWProgram
UnivFaculty
UnivMFAProgram
Vendor
WritersGroups

Other Resources
Af-AmProgramming
ChildrensProgramming
LatinoProgramming
MinorityProgramming
NativeProgramming
SeniorProgramming

Membership Fee
$75: Individual
$55: Senior (age 65 or older)
$55: Student
$55: Disabled
$130: Household
$130: 2-Year Individual
$150: Institutional
$0: Complimentary
$55: Promotional Discount Membership

Membership Status
New
Renew
Rejoin

Tender
Credit Card
Check
Cash
In-Kind