

	Moving? New phone number or email address? Having your current contact information is very important to us. It's the only way we can make sure we can reliably provide services and resources for our members. If you are making a change in your name, or were previously in our database under another name, enter that name in the field Former Name.
		Login ID:

	I would like to view the *SCBWI Bulletin* online** rather than receive a printed copy through the post :

	I would like to receive email renewal notifications instead of snail mail paper notices:

	First Name:	(required)	example: Samuel
	Middle Name:		example: L
	Last Name:	(required)	example: Clemens
	Name Suffix:		example: Jr.
	Former Name:	(optional)
	Telephone Number:
	Fax Number:
	Email Address:		(required)
	Company:
	Web URL Address: *		example: www.yoursite.com
	Your name as it should display on our member links page.	First Name: Last Name:	example: Mark example: Twain

	Street Address:	(required)
	Address continued (if needed):
	City:	(required)
	State:
	Province:
	Zip Postal Code:	(required)
	Country:

	Pseudonym(s):

	Occupation: (Select all that apply)	Artist Editor Film or Television Illustrator Multimedia Publisher Writer
		Other:

	Are you published in the children's literature market?		Yes		No
	If you answered yes to the above question, please provide:
	A recently published title:
	The year it was published:
	The name of publisher:
	Are you published in a market other than children's lit.?		Yes		No


	I do not wish to be listed in the annual roster of members. The SCBWI roster is a directory of all current members, including name, mailing address and email information. The roster is never given out or used for outside commercial purposes. * A web URL address entered by an active full member is automatically displayed as a link on www.scbwi.org. If you prefer not to be linked, leave the above Web URL Address field blank.