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Arkansas Press Women - Application for Associate Membership
Annual membership dues are $25 for Associate Membership level
Make checks payable to Arkansas Press Women
Mail checks to Richard Plotkin, 250 Four Winds Dr.
Conway, AR 72034
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Contact Information
Name
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Your answer
Company/School
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Your answer
Job Title/Description
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Preferred Phone Number
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Preferred Email Address
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Home Address
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Business/School Address
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Your answer
Which medium best describes your communication work?
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Freelance
Book Author
Education
Newspaper
Radio
Television
Online
Magazine
Public Relations
Trade Publication
Newsletter
Other
Which region of Arkansas do you live in?
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Northwest
Northeast
Central
Southwest
Southeast
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Membership Information
Why are you interested in joining Arkansas Press Women?
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Your answer
What services or opportunities do you expect from this organization?
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Membership Dues
*
I understand that associate member dues are $25 per year. Membership follows the calendar year.
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Would you be willing to consider full membership next year?
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Arkansas Press Women emails a newsletter to all of its members using MailChimp. If you do not want to receive this email, please opt out below.
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