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.





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