View Cart   
Home > Membership Payment Form

Membership Payment Form

Use this form to join or renew your GPS membership. After filling out this member information form, you will be guided to a secure payment page.
Username:
Password:
Confirm Password:
First Name:
 Middle Name/MI:
 LastName:
Street Address, line 1:
 Street Address, line 2:
 City:
State:
 ZIP:
 Email:
Website (e.g., mysite.com):
 Home Phone:
 Office Phone:
Cell Phone:
 FAX:
 Occupation:
Name of Your Hometown Newspaper (to be used for press release):
 If this is an application for family membership, please list the other family members (each on a separate line) who will be included in the membership:
Please list your books or other publications (each on a separate line) in which your work has appeared, if any:
Please list any awards, honors, or prizes (each on a separate line) you have won for your work:
How did you hear about the Georgia Poetry Society?
Type of Membership:
If you are joining as a student, please provide the following information:
Your age:   The name of your school:    Your grade:
Volunteer: I would like to help GPS with
After completing this form, click the Next button to pay the membership dues online
 


 


@ 2010, Georgia Poetry Society, All Rights Reserved.