Membership
Application

 

Name
Newspaper or Company
Address
City
State ZIP
Phone
Fax

email

Please check the appropriate category:
  
I am:
 
actively in charge of the circulation department of a newspaper of general
circulation published or distributed in California, Arizona, Nevada, Hawaii or Utah.
a person who actively oversees the management of the circulation departments of two or more newspapers of general circulation published or distributed in California, Arizona, Nevada, Hawaii or Utah.
employed by a newspaper of general circulation in a management position.
an individual who owns, manages or represents a business directly affiliated with the newspaper industry.
Date  
Membership Fee $75.00

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Name as it appears on card

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