Partner Membership Form

Christian Indie Publishing Association > Partner Membership Form

Partner Member Application

To renew your partner membership,
just use the payment button to the right:

To become a CIPA Partner Member, you can either print this form and mail it to us with a $100 check for your membership through December 2021, or fill out the data below and pay using the PayPal button following. All fields are required.

Contact Name

Contact Title

Contact Email

Contact Phone

Company Name

Company Website

Company Address

City

State

Zip

Country

Company Phone

Company Fax

Describe the services your company provides to publishers and authors:

Describe any special instructions CIPA members should use to contact you:

What other partner member opportunities would you like CIPA to offer:

By checking the above box, I acknowledge that all individuals representing the above-listed company will conduct themselves in accordance with CIPA’s code of conduct. I certify that the above information is correct.

Fill out the data above and click Submit before using the PayPal button below to pay for your membership. You will be charged $100 for your membership dues through December 2021.