Publication Member Update

This form is best suited when you have a lot of changes. Changes may also be submitted in an email, if that is more convenient, addressing only those items that need to be updated.

Please fill in the form below in the appropriate sections to update your information. Thank you.
Publication Name*
Publication Owner/Organization
Mailing Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone (for directory)*
This is the phone number we will publish publicly in the annual directory.
Email (for directory)*
This is the email address we will publish publicly in the annual directory. Publications often use a generic address here (i.e. info@ or contact@).
Website
Primary Contact Person*
This is the person to whom we will direct official EPA business, such as renewal reminders and contest deadlines.
First Last
Primary Contact Title*
Primary Contact Phone*
Primary Contact Email*
Issues per Year
Circulation (print)
Web Traffic (digital)
Do you accept freelance material?
Do you carry advertising?
Do you publish reviews?
What is Your Subscription Rate
Write a brief description of your publication.
50 word limit.
Publication Staff List*
Include names, titles and email addresses for each staff member who specifically works on your publication. Please include all editorial, design and production staff. 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.
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Name	Title	Email

Name	Address	City	State	Zip