Industry Enrollment & Dues - Mountains and Plains Independent Booksellers Association

Fiscal Year July 2020 to June 2021

Organizations will have access to membership benefits as soon as dues are paid.

Organization Information

Publisher/Organization/Author 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

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.

Name of Voter

Voter's Email

Voter's Phone Number

Payment

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