Join the NYCIP

Become an NYCIP Member

What Type of Membership Would You Like?

  Publisher Membership (more info)

  Friends & Corporate Membership (more info)



Bold red fields are required.

Account Information

Company Name:
   
Contact Person First Name:
Contact Person Last Name:
 
Street Address:
City:
State:
Zip:
   
Public Phone:
Private Phone:
Fax:
   
Email Address:
Website (include http://):


Review Your Information

: $

Account Information

Company Name:
Contact Person:

Address:
,

Phone Number:
Other Phone:
Fax:

Email Address:
Website:

Publisher Business Information

Year Founded:

No. of books published:

Description:

List 2 titles to be displayed on
NYCIP shelves (free):
1.
2.
   
Additional Titles at $15 each*:
3.
4.
5.
6.


Categories:
1.
2.
3.

*If you wish to list more than 6 titles, please contact us.


If this information is correct, please create a password for your member account (your username will be the email address you have provided above). You will be taken to PayPal to make your payment when you hit Confirm & Pay.
Password:
Verify Password:


Thank you for your support of the New York Center for Independent Publishing!

You will receive a confirmation email shortly with login instructions. You may login to view your account but your membership will not be made active until your PayPal payment has been received and cleared. Don't forget — all membership fees are tax-deductable so save your receipts!

: $
for

Don't want to fill this out online? Publishers Mail-In Form | Friends & Corporate Mail-In Form
All contributions are tax-deductible. All Memberships are valid for one year from month of purchase unless otherwise specified.