Membership Application

Association of Community Publishers
Membership Application
Date

Month Day Year
Date
Company Name
Official Representative
(Person responsible for all official ACP business including invoices, voting rights, annual meetings, etc.)
Official Representative Email
example@example.com
Network Contact Person (for ad placements)
Network Contact Person Email
example@example.com
Company Address
City
State
Zip
Total Circulation
Audit Company
% Mailed
% Carrier
% Rack
Number of Banners / Editions at this business unit
DMA
% Editorial Content
Distribution Day
Phone
Fax
Web Site
Parent Company
Number of Editions / Banners

Number of Editions / Banners:

	List Banner Names, Circulation, Deadline Day (or include media kit)