Please list your name below as you would like it to appear on the public portion of the website:

First Name:   Last Name:

Select one: new member or  Renewal of Lapsed Membership

Also Known As (if applicable - for PASIC reference only):

Email address:   RWA No.:     

Street Address:

City:   State:     Zip:

Day Phone:     Night Phone:   

Fax:   

Qualifying Novel:

Publisher/Line:

ISBN:      Release Date:

Applying for provisional membership? Yes/No

If yes, editor’s name: 

New Members: Submit your payment via Paypal for annual dues of $35, plus a $5 new member processing fee for a total of $40 in United States funds if joining between June 2nd and December 31st. If joining between January 1st and June 1st, pay the half-year rate of $17.50 plus the $5 processing fee, for a total of $22.50. Since all PASIC members pay annual dues on July 1st, new members joining from January 1st to June 1st (and paying the half year rate) will then owe $35 again on July 1st.

Renewing a Lapsed Membership: If re-joining between June 2nd and December 31st, pay annual dues of $35, plus a re-processing fee of $10, for a total of $45. If re-joining between January 1st to June 1st, pay the half-year rate of $17.50, plus a re-processing fee of $10, for a total of $27.50. On July 1st, annual dues of $35 will again be due.

New members will receive Welcome Packets which will include a PASIC pin.

Revised 10/07

NOTE: Once you submit this form, you will be sent to a confirmation page to submit your membership fees via Paypal.