MYSTERY WRITERS OF AMERICA
New York Chapter
2024 MENTOR PROGRAM APPLICATION
NAME (and Pen Name if any)_________________________________________
PHONE NUMBER:_________________________________________________
I confirm that I am a paid-up member of MWA-NY (Check here) __
RELEASE
I acknowledge that I have requested a mentor from the New York chapter of Mystery Writers of
America to review my manuscript entitled___________________________________________
and provide editorial and publishing advice regarding the manuscript. In connection therewith, I
hereby release Mystery Writers of America, its employees, agents, and representatives, and the
reviewer from all claims, suits, and damages related to or arising from this review and the advice
provided, including but not limited to any claim of copyright infringement or use of intellectual
property.
SIGNATURE OF AUTHOR:____________________________________
PRINT NAME OF AUTHOR:___________________________________
DATE:______________________________________________________
MAIL COMPLETED FORM AND A $25 CHECK PAYABLE TO MWA-NY TO:
SHEILA MAYHEW (ATTN: MWA-NY MENTOR PROGRAM)
49 MORSE AVENUE
BLOOMFIELD, NJ 07003
REMEMBER: DO NOT SEND YOUR MANUSCRIPT WITH THIS RELEASE FORM.
MANUSCRIPTS MUST BE SENT ELECTRONICALLY TO mentors@mwany.org .
THE RELEASE FORM AND CHECK MUST BE SENT BY REGULAR MAIL.