MEMBERSHIP APPLICATION

                                                                                                           Date ____________________

Name _______________________________            Birth Date (Month/Day only) ____________

Address ______________________________________________________________________ 

City _____________________________  State _______  Zip _______  Phone ______________

Email Address ______________________________________________________________

                      Unpublished __________                    Published __________

1.  Publisher ___________________________________________________________________

     Title ________________________________________    Genre ________________________

     Pseudonym ____________________________________________

     Month/Year Most Recent Book Published ____________________

2.  Publisher ___________________________________________________________________

     Title ________________________________________    Genre ________________________

     Pseudonym ____________________________________________

     Month/Year 2nd Most Recent Book Published ____________________

3.  Publisher ______________________________________________

     Title ________________________________________    Genre ________________________

     Pseudonym ____________________________________________

     Month/Year 3rd Most Recent Book Published ____________________

How did you hear about ORA? ____________________________________________________

Please make checks payable to Ozarks Romance Authors and mail along with application to:
3953 W. Groton Street, Springfield, MO 65803

Annual Membership fee of $25 is due at the beginning of each fiscal year (October)
and will be prorated $2.00 per month if joining in a different month.

Oct:  $25                               Nov:  $23                               Dec:  $21                               Jan:  $19
                Feb:  $17                               Mar:  $15                              Apr:  $13                               May:  $11
                June:  $9                               July:    $7                              Aug:    $5                              Sept:    $3