Application

Your Subtitle text

Application

JOIN MIPA

TO PAY BY CHECK: Complete the form, print, and make your check payable to Midwest Independent Publishers Association. Mail to MIPA, PO Box 65686, St. Paul, MN 55165. Upon receipt of your completed registration form and check, we will confirm your membership by email.

TO PAY ONLINE: Complete form and click on submit. Then select your membership option and click on PayPal. You can also pay here with your credit card. Upon receipt of your completed registration form and check, we will confirm your membership by email.

Any questions? Contact our membership director, Seal Dwyer, 320-558-9062 or email.

Applicant Information
Name:
Company Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Select One:	Publisher Writer Vendor Other
	Check box if you DO NOT want us to add your name to the MIPA Directory.
Contact Information
Phone:
Alternate Phone:
Website:
Email:
Membership Options
Member:	$50 per year
Additional company member:	$25 per year each
How many additional members?	Separate registration form required for each
Student member:	$25 per year
__________________________________________________________________________ Submit application:

MIPA is an affiliate of IBPA, the Independent Book Publishers Association