Alabama Media Professionals

Membership Application

Please complete this form and submit it by any of the following methods:

- Via e-mail to membership@alabamawriters.com 
- In person at any AMP meeting
- Via US mail to AMP's current membership Officer

Name:  __________________________________

Applying for:   	[  ]  Professional (standard) membership ($68/year)
			        [  ]  Student membership ($25/year)
		  	        [  ]  Retiree membership ($25/year)

E-mail: __________________________

Home:
Address:  	    __________________________
City/state/zip:	__________________________
Phone:	        __________________________


Work:
Company:	    __________________________
Title:		    __________________________
Address:  	    __________________________
City/state/zip:	__________________________
Phone:	        __________________________

Date submitted: __________________________

Optional:  Referred to AMP by   _________________________

Your membership will be activated upon receipt of your payment. 
Make checks payable to Alabama Media Professionals.

Thanks, and welcome to AMP!

Lori Culpepper, Vice President-Membership, 112 Tocoa Circle, Helena, AL  35080