|
Please print legibly or type out this information, thank you.
Name:_____________________________________
E-mail: ____________________________________
Address:______________________________________________________________________________
City:___________________________ State:_____ Zip:_______
Telephone:_______________________
Age:_____ F/T or P/T Writer:_____ NSFAA
Member? Y/N, Would You Like To Join? Y / N:__________
Please Send Information
About: The National Short Fiction Author's Alliance: Y___ N ___
If you are paying with PayPal - you will only be able to purchase the
Reading level membership. If you want additional books and other levels
of membership, send us your request and we will send you an email with a
link to PayPal for the amount of your entire purchase.
Reading Membership Fee for One Person:.$ 28.95
(Includes one
copy of the current book)
Additional
Books:( ) qty........ X $
14.95 $________(Please limit to 5 books maximum)
Additional Books (wholesale):... X
$ 6.00 $________(24 books minimum case price discounts)
Student Membership:................X $
15.00 $________(A copy of full time class registration required)
Additional Member:...................X $
25.00 $________(Includes a one copy of the current book)
Total Fee Submitted:............................$________(Please
make checks to: Timson Edwards, Co.)
VI / MC / DI / AX Credit card #
_____________________________________ Expiration Date: ___ / ___
Signature as shown on back
of card:
_______________________________________________________
By signing this order, as authorized user of this card, I authorize you
to charge this purchase on this card.
Please send a photo
copy of the back and front of card in order to process this order by
credit card.
Please return your completed and
signed application and check to:
Timson Edwards, Co. PO Box 55-0898
Jacksonville, FL 32255-0898
If paying by credit card, please mail this form to
us at the address above
|
