Bookbuilders West Membership Application Form

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Please consider accepting the following firm as a member of Bookbuilders West.

___ Publisher member	___ Supplier member

Firm Name: _____________________________________________________________

Telephone: ___________________________      E-mail: ____________________

Address: ________________________________________________

City, State, Zip: ______________________________________________________

Individual making application: _________________________________________

Your Role/Title: _______________________________________________________


___ Publisher Member 	Please describe the nature of the published products. 

_________________________________________________________________________

_________________________________________________________________________

	
___ Please describe the editorial, design, or production service that you, 
    an individual in a one-person company, offer to publishers, and list
    names of several publisher clients.

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________


___ Supplier	Check one or more of the following:

    ___ Printer    ___ Binder    ___ Compositor    ___ Product Manufacturer

    ___ Art, Design, or Production Service    ___ Other ___________________


Please list names of several publisher clients:

_________________________________________________________________________

_________________________________________________________________________

Please describe production services or products manufactured:

_________________________________________________________________________

_________________________________________________________________________


___ One- or two-person company: $50     

___ Company of 3 to 9 people: $125    

___ Company of 10 or more people: $275 


If approved for membership, the applicant or firm understands that it will 
be billed for the above dues and agrees to all rules and regulations of 
Bookbuilders West.

Please mail this application to:
	Membership Committee, Bookbuilders West
	c/o Don Smith
	1175 Richardson Avenue
	Los Altos, CA 94024


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