EMPA Membership Application

Name_________________________________________________________________________
Address_______________________________________________________________________
Home Tel: ___________________________Business Tel:______________________________
E-Mail Address_________________________________________________________________
Media Affiliation and their Address _____________________________________________
________________________________________________________________________________
_________________________________________________________________________________
Tel: of Media Affiliation___________________________________________________________
Length of Time with them_______________________________________________________
Position_______________________________________________________________________

Please Check One:
Weekly_______   Monthly_________  Radio ________  TV_______ Internet________
Other_______

Please Check One:
Part Time_______    Full Time________

Type of Membership:
Professional________    Associate________  Corporate__________

 

Mail application and checks to:
EMPA P.O. Box 8547
Trenton, NJ 08650

 

New Press members please include tear-offs of your published work with this application.