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Bookstores
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Friends of MPIBA
Booksellers
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Reading the West
Great Summer Reading Guide
Holiday Marketing Program
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Regional Bestsellers
Regional Job Postings
Financial Assistance
Publishers
FallCon
SpringCon
Summer Camp
Great Summer Reading Guide
Holiday Marketing Program
Reading the West
Promote to the Region
Advertising Opportunities
Promote Your Specials
Calendar
About
Our Mission
Bookstores
Staff
Board of Directors
Join
Bookstores
Publishers & Vendors
Friends of MPIBA
Booksellers
FallCon
SpringCon
Summer Camp
Reading the West
Great Summer Reading Guide
Holiday Marketing Program
Resources
Education & News
Regional Bestsellers
Regional Job Postings
Financial Assistance
Publishers
FallCon
SpringCon
Summer Camp
Great Summer Reading Guide
Holiday Marketing Program
Reading the West
Promote to the Region
Advertising Opportunities
Promote Your Specials
Calendar
About
Our Mission
Bookstores
Staff
Board of Directors
Industry Membership Enrollment Form, Fiscal Year 2021-22
This form is for publishers, wholesalers, distributors, commission sales groups, and non-book vendors. All other prospective industry members (i.e. authors, librarians) should use the
Friends of MPIBA
membership form.
Organization Information
Organization Name
*
Select Your Membership Category
*
Publisher
Commission Sales Group
Wholesaler
Distributor
Non-Book Vendor
Other
Other - Please Specify
*
Your Name
*
First
Last
Email
*
Phone
*
Mailing Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Who else from your company should be included on our contact list?
Name
Job Title
Email Address
Designated Voting Member
One representative from each Active Industry Member organization is allowed to vote on association business. If your organization would like to participate in votes, please indicate your voting member below.
I am the voting member
I am my company's voting member
Voter's Name
First
Last
Voter's Email
Contact for Bookseller Members
One benefit of your membership is being listed on our website in the Vendor Database. Below you may provide the information you would like us to share with our booksellers. If there is any information you would not like listed, simply leave the field blank.
Company Website
*
Name of Primary Contact for Booksellers
Phone
Email
Brief Description of Company
Optional Additional Information
Payment
Optional Donation to Support our Bookseller Grant Programs
Donations support MPIBA's various bookstore grant programs, including travel, professional development, and store improvement grants.
Coupon Code
Total
$0.00
Credit Card
Card Details
Cardholder Name
Δ