Annual Renewal Form – Publications

Renewal - Publication Members

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 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.
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
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
Supported Credit Cards: 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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