THE WRITING ACADEMY
Membership Application Form

Please complete this form and mail it (along with the application fee and optional writing sample) to Inez Schneider, New Member Coordinator, 4010 Singleton Road, Rockford, IL  61114. (815-877-9675)

Name __________________________________________________________

Address ________________________________________________________

City __________________________ State _______ Zip code _____________

Home phone _________________  Business phone _____________________

Email _______________________ Fax _______________________________

In the space below, please briefly describe your writing experience--education, publications, professional experience in writing or editing. Continue on the back if you need more space.

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Instructions for Optional Writing Sample

You may submit a published or unpublished writing sample of no more than 500 words of prose on any topic. Or if you prefer, you may write 500 words or fewer on one of the following suggested topics. 1. Write about a childhood event that significantly affected your life. 2. Write about a place that is important to you. 3. Write about an object that is important in your life. 4. Write about a teacher who deeply influenced you.

Use standard manuscript format (double spaced in a clear, readable type), with your name, address, and telephone number in the upper left corner of the first page. Your name, an abbreviated title of the piece, and the page number should appear on each subsequent page.

When you apply--or before you apply--feel free to request more information about a particular course, our instructors, or critique partners.

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