America's Newspapers

Associate Membership Application

* Fields are Required

Company Information

Company Name: *

Address: *

City: *

State: *

Zip:

Country:

Province/Other:

Company website address: *

No. of employees: (in full-time equivalents)

Key Company Contact

Name: *

Title: *

Email: *

Phone: *

Address: *

City: *

State: *

Zip:

Billing Contact: *

Title: *

Email: *

Phone: *

Address: *

City: *

State: *

Zip:

Other Key Contacts

Name 1:

Title:

Email:

Phone:

Name 2:

Title:

Email:

Phone:

Provide a brief description of your company, including the services you provide to the newspaper industry: *

* Please provide a list of newspaper or media companies you currently provide services to:

Logo

Please provide a digital version of your logo:

Attach photograph in JPEG/JPG or PNG format: (File size limit is 5MB) Find file

* Not a robot? Solve this equation: 14 x 2 =