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

Fiscal Year July 2020 to June 2021

Store Information

Bookstore Name*

Select Your Membership Category*

Membership Contact Name*

First Last

Email*

Phone*

Mailing Address (Not for Publication)*

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

Bookstore Address (If your store does not have a permanent physical address, please put a note in the address field (ie. pop-up, on-line only, etc.)*

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

Bookstore Website*

If your bookstore does not have a website, please enter NO WEBSITE in the box below.

Designated Voting Member

One representative from each member bookstore is allowed to vote on association business. Please indicate the voting member of your store below.

Name of Voter*

Voter's Email*

Voter's Phone Number*

Payment

Membership dues are waived for the current fiscal year. Please skip this section unless you would like to make a donation to support our grant programs.

Donation - Bookseller Grants

Donations support MPIBA's various bookstore grant programs, including travel, professional development, and store improvement grants.

Coupon

Credit Card

Card Details

Cardholder Name

Total

$0.00