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FOR THE USE OF CURRENT MEMBERS ONLY
Please do NOT send money if you are not a current member.
Member Registration Form
We ask that all members furnish this information annually in order to keep
our records up to date.
Dues are $40.00
NAME: ____________________________________ DATE: __________________
ORGANIZATION (if applicable): __________________________
CITY: _________________ STATE: _______ ZIP: _______________
PHONES: (Day) ____/____-_______ (Night) ____/____-_______
E-MAIL (will be encrypted to prevent spam): ________________________
WEB SITE (if any): http://
Please check appropriate box: Author Member Associate Member
Please check the box/es that apply in the form below to inform us of your intentions.
Patron Level: A gift of $500 or more.
Sponsor Level: A gift of $250 or more.
Fellow Level: A gift of $100 or more.
Donor Level: A gift $50 or more.
Friend Level: A gift of any amount.
Dues only: $40.00
Enclosed is my check for $_______________ (payable to Society of Midland Authors).
Mail to (Please do not send money unless you are a current member.):
Society of Midland Authors
P.O. Box 10419
Chicago, IL 60610