_____ Active ($25/Year), _____ Sustaining ($30/Year), _____ Junior, under 18 ($10/Year)
I am a writer of ____ poetry, ____ fiction, ____ non-fiction, and/or ____ I am
interested in the literature and history of California as an appreciator.
Name_____________________________________ Phone ____________________
Address_____________________________________________ Zip____________
Send this form with remittance to: The Ina Coolbrith Circle, Gayle Eleanor, Treasurer,
4483 Clear Creek Court, Concord, CA 94521.
Please list any literary accomplishments: ___________________________________
__________________________________________________________________
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