Missouri Interscholastic Press Association
Membership Form 2016-2017
Name of School
Your answer
School Address
Your answer
City
Your answer
Zip Code
Your answer
Enrollment
Number of advisers in school
Adviser 1 (Check all that apply)
Adviser 1 Name
Your answer
Adviser 1 Email
Your answer
Adviser 1 Phone
Your answer
Adviser 1 Cell Phone
Your answer
Adviser 2 (Check all that apply)
Adviser 2 Name
Your answer
Adviser 2 Email
Your answer
Adviser 2 Phone
Your answer
Adviser 2 Cell Phone
Your answer
Adviser 3 (Check all that apply)
Adviser 3 Name
Your answer
Adviser 3 Email
Your answer
Adviser 3 Phone
Your answer
Adviser 3 Cell Phone
Your answer
Adviser 4 (Check all that apply)
Adviser 4 Name
Your answer
Adviser 4 Email
Your answer
Adviser 4 Phone
Your answer
Adviser 4 Cell Phone
Your answer
Yearbook
Publication Name
Your answer
Web address
Your answer
Delivery
Social Media Handles
Please note Facebook, Instagram, Twitter, etc. along with the handle
Your answer
Newspaper/Newsmagazine
Publication Name
Your answer
Web address
Your answer
Type of Publication
Frequency of Publication
Social Media Handles
Please note Facebook, Instagram, Twitter, etc. along with the handle
Your answer
Broadcast
TV Broadcast Name
Your answer
TV Broadcast Channel
Your answer
TV Broadcast Web Address
Your answer
Social Media Handles
Please note Facebook, Instagram, Twitter, etc. along with the handle
Your answer
Radio Broadcast Name
Your answer
Radio Broadcast Channel
Your answer
Radio Broadcast Web Address
Your answer
Social Media Handles
Please note Facebook, Instagram, Twitter, etc. along with the handle
Your answer
Online
Website Name
Your answer
Web Address
Your answer
Social Media Handles
Please note Facebook, Instagram, Twitter, etc. along with the handle
Your answer
MEMBERSHIP AND PAYMENT METHOD
$225 Entire School (4+ publications/programs)
$190 3 publications/programs
$140 2 publications/programs
$75 1 publication/program
$40 Middle School/Junior High Membership
$100 Associate (Non Teacher individual or organization)
$0 Honorary (Retired from teaching)
Select Membership Type
Early Bird Discount
Before Sept. 1
JEA Membership $60 per adviser
be renewing though MIPA, the organization receives $5 for each membership
Donation to Student Press Law Center
SPLC does so much for scholastic press rights. Help support them now.
Your answer
Late Fee
After Dec. 1
TOTAL AMOUNT DUE
Enter the total of your membership choices.
Your answer
Payment Options
Mentor Program
If you would like a mentor or would like to work with new advisers, sign up here.
Membership Submission
Please save/print the form BEFORE submitting in case you need a copy for purchase orders and records. Right click and choose print. Change your printer to PDF. Save the form.

If you are completing this online, please just hit the submit button and relax. You can also edit if needed.

If you are emailing the PDF version of the form, please email it to mipa@missouri.edu

If you would like to mail a hard copy to the office:
MIPA
Missouri School of Journalism
132 Neff Annex
Columbia, MO 65211-1200

If you have any questions or concerns, please email mipa@missouri.edu or call (573) 882-6031

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