Active Membership Application

Name of Publication

Primary Contact First Name

Primary Contact Last Name

Address 1

Address 2

City

State

Zip

Phone

Web Site

Date Established (must have been published for 1 year before membership can be approved)

Publication Frequency

Circulation

Audited by

Key Personnel: list all of your key personnel, their titles, and their email addresses (for example, Publisher, Editor, Advertising Director, etc.)

Briefly describe why you want to be a member of VPA:

Please note that by submitting these materials you are not automatically a VPA member. There is a review proces that is carried out after this form is submitted and your payment has been received.

Timeout Warning

Active Membership Application