Fed Up Publishings’ Membership Application- Pre-Initiation Requirements and Questionnaire
Basic Information Questionnaire
Section 1 - Personal Information
1. Full Name
*
First Name
Last Name
Address/Mailing Addrss
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
2. Email Address
*
example@example.com
3. Phone Number (Optional)
Please enter a valid phone number.
Format: (000) 000-0000.
4. Date of Birth
*
-
Month
-
Day
Year
Date
Which of the following best describes your affiliation with the U.S. military community?
*
Please Select
Active Duty Service Member
National Guard or Reserve
Military Veteran
Retired Service Member
Military Spouse
Military Family Member / Dependent
Civilian Employee of DoD or Military Installation
Military-Connected Business Owner
Employer of Military or Veteran Employees
School or Educational Institution Supporting Military Families
Support Organization or Nonprofit
Other (please specify)
Not Affiliated
If other, please specify below:
Location
City/Town
*
State
*
Social Media (optional)
Username and Platform
Professional Title
Type a question
*
Self-Published Author
Librarian
Parent
Student
Teacher
Business
Enthusiast
Employee/Contractor
Academic Background
Advanced Education Level
*
High School Diploma/GED
Trade (1+ years)
Some College (less than 2 years)
Associates Degree (2+ years)
Bachelors Degree (4+ years)
Masters Degree (5+ years)
Doctorates Degree (6+ years)
Other
Submit
Should be Empty: