Mountains and Plains Independent Booksellers Association

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Mountains & Plains
Independent
Booksellers
Association

19 Old Town Square
Suite 238
Fort Collins, CO 80524

800-752-0249
970-484-5856
970-407-1479 fax

ONLINE APPLICATION FORM - PUBLISHERS AND BOOK INDUSTRY PROFESSIONALS

Please complete this form; you will be prompted to make payment for your dues online.

The membership year runs from July through June.
New members joining December through June will pay pro-rated dues of $60.00.

Who Can Join MPIBA?
Please check a membership category below:

Professional Members
Dues are $100.00 per year.
Publishers, wholesalers, and their representatives having regularly conducted business with booksellers in the MPIBA region.* These are voting members and are eligible to serve on the Board of Directors.

Merchant Associate Members
Dues are $100.00 per year.
Prospective booksellers, independent bookstores outside our region, and independent businesses who do not identify themselves as primarily booksellers. These are not voting members, and may not serve on the Board of Directors.

Industry Associate Members
Dues are $100.00 per year.
Agents, publicists, and non-book vendors. These are not voting members, and may not serve on the Board of Directors.

*The MPIBA Region:
Arizona, Colorado, Idaho, Iowa, Kansas, Montana, Nebraska, New Mexico, North Dakota, Oklahoma, South Dakota, Texas, Utah, and Wyoming.

Membership Application
Name:
Title:
Business Name:
Mailing Address:
Street Address:
City:
State:
Zip:
Phone:
Fax:
E-mail Address:
Website Address:

Please indicate which of the following categories applies to you:
Publisher
Wholesaler
Sales Rep
Sidelines Manufacturer
Marketing/Advertising
Other
If “other” please describe your business:

If you are a publisher with sales reps in our region, please give their names, phone numbers and e-mail addresses:
Sales Rep #1
Name
Phone Number
E-mail address
Sales Rep #2
Name
Phone Number
E-mail address

I would like to receive advertising information for:
Winter Catalog
Fall Book Camp
Spring Meeting
Handbook
Print Newsletter
E-Newsletter
Website

I would rather not join MPIBA at this time, but would like to subscribe to your newsletter ($25.00).

I would rather not join MPIBA at this time, but please send advertising information for:
Winter Catalog
Fall Book Camp
Spring Meeting
Handbook
Print Newsletter
E-Newsletter
Website

info@mountainsplains.org