Bookseller Membership - Enrollment & Dues - Mountains and Plains Independent Booksellers Association

Fiscal Year July 2019 to June 2020

Bookstore Name*

Select Your Membership Category*

Membership Contact Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Donation - "Give a Bookseller a Lift"

Supports grants to booksellers to attend MPIBA events

Total

$0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Bookseller Membership – Enrollment & Dues