First Name:
Middle Initial:
Last Name:
Street Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Email:
Male
Female
What type of books do you like to read?
Why do you want to be a member of this club?
What do you hope to gain from membership with F.I.R.E.?
Are you a:
Reader
Writer
Aspiring Writer
If you are sponsored, who is your sponsor?
How did you hear about F.I.R.E.?
Internet
RSJ
Member/Sponsor
Other:
Thank you very much for your interest in F.I.R.E., someone will be getting back to you shortly.