WIPP: Women in Periodical Publishing : Online Member Sign-up Form

Your Name:

Your email:

Please choose one:

Dr.

Ms.

Mr.

Please choose one:

Male

Female

Your Position:

Your Company:

Address:

Address 2:

City:

State:

Zip:

Country:

Business Phone:

Business Fax:

Years in Publishing:

Magazine Type (Consumer or Trade):

Your Highest Educational Degree:

Would You Like to become a mentor or be mentored?:

Yes

Membership Fees: (Annual Membership):

Regular ($75) Voting Member

Student* ($35) Non-Voting

Corporate Board Member ($1500)

I would like to receive the WIPP Wired Newsletter:

Yes

(Announcements)