Inland Empire Chapter - Romance Writers of America

Name: ________________________________________________

Address: _____________________________________________

______________________________________________________

Telephone: ___________________________________________

E-mail address: ______________________________________

National RWA® Membership Number: _________

Title of Entry: _________________________________________________________

Category: Circle one, for information only. Entries will not be divided by
category. There will be one winner overall.
1) Contemporary
2) Historical, including Regency
3) Paranormal

I understand that judging is subjective, and I will accept the judges' decisions, which are final. I understand and accept that ideas and titles cannot be copyrighted. I shall hold Inland Empire RWA, its officers and members, the contest judges and coordinator, harmless. I also verify that I am the author of the enclosed entry, that it was not accepted for publication at the time of submission, and that I have not been published in romance fiction for three or more years. I shall waive any and all claims I may have for damages or losses of any kind arising from my submission of an entry into this contest.

Signed: ________________________________________________________
Date: _________________
Amount enclosed: _________ Check #: ________

Mail fee, check payable to "IECRWA" along with your entry to: