Annual Renewal Form – Publications

Completing this form in the course of membership renewal ensures EPA has the most current information on your publication. If you are renewing multiple publications and the staff list is the same for each, there is no need to repeat all the staff info. Simply note in the comments box to include the same staff -- or designate which ones if not all repeat. We appreciate your cooperation.

If you have both print and online/digital memberships or you want to add an online/digital membership to your print membership, you will see an option to pay for the digital membership near the bottom of the form.

Publication Name*

Publication Owner/Organization

Mailing Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone (for directory)*

Email (for directory)*

Website

Must include http:// at the beginning.

Primary Contact Person*

First Last

Primary Contact Title*

Primary Contact Phone*

Primary Contact Email*

Issues Per Year*

Circulation per issue (print)*

Digital-only members should enter 0.

Monthly Web Traffic (digital)*

This should be an estimate of the number of MONTHLY visitors to your website or blog. If no website, enter 0. If unknown, enter unknown. e-Newsletters should enter the number of subscribers/recipients for a single e-blast.

Do you accept freelance material?*

Yes
No

Do you publish reviews?*

Yes
No

Do you carry advertising?*

Yes
No

What is your subscription rate?

Publication Staff List*

Include the names for each staff member who specifically works on your publication (editorial, design, production, etc.). Please add job titles and email addresses ONLY for new staff added in the past year). Click the plus sign to add more lines.

Name	Title	Email

Addresses for Remote Staff

If any of your publication staff listed above works remotely away from the publication headquarters, please enter their name and mailing address here in order for EPA to mail Liaison directly to them. Click the plus sign to add more lines.

Name	Address	City	State	Zip

Optional Comments

Anything you need us to know? Tell us here.

Annual Membership Dues*

Choose your dues level based on circulation or other applicable category from the drop-down menu.

Print Publication Member Website (Digital Add-on Option)

Members who already hold a dual membership may choose this option to pay for both print and digital memberships simultaneously. Members with only a print membership may also choose this option to add a digital membership for the first time.

Digital Membership Add-on
No Add-on

Optional Donation

You can support the work of EPA through an additional contribution beyond your annual dues.

Total

$0.00

Pay Now

Payment now by credit card is preferred, but not required. You'll get a credit card confirmation receipt emailed to you immediately. Later, we'll email you a sales receipt for your records.

Pay by credit card

Pay Later

We'll generate an invoice and email it to you.

Bill us

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address for Credit Card*

Street Address City State / Province / Region ZIP / Postal Code Country

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Renewal - Publication Members