Publishers, Sales Reps & Book Industry Professionals
Publishers, Sales Reps, Wholesalers, Sideline/Supply Vendor/Literary Agents
Company
Name
*
First Name
Last Name
Email
*
Website url
Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Phone Number
*
Fax Number
Renewing or New Member?
*
Renewing
New
Details
Sales Rep
Publisher
Wholesaler
Literary Agent
Sideline/Supply
Add my email address to the following:
Wed. Newsletter & Bestseller List
NCCBA (children's) Google list-serve
Is there anything else we should know?
Payment Options
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Publishing Associate
$
150.00
Additional Associates
$
75.00
Quantity
1
2
3
4
5
6
7
8
9
10
Large House (includes up t0 6 sales reps)
$
550.00
Additional Large House Sales Reps (more than 6)
$
75.00
Quantity
1
2
3
4
5
Small House & Commission Reps Group (up to 3 sales reps)
$
250.00
Additional Small House & Commission Rep Group
$
50.00
Quantity
1
2
3
4
5
Total
$
0.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
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