Missouri Interscholastic Press Association
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Membership Form 2017-2018
Name of School
School Address
City
Zip Code
Enrollment
Clear selection
Number of advisers in school
Clear selection
Yearbook (YB) Information
Please leave blank any questions that do not apply.
 YB Publication Name
 YB Delivery
Clear selection
YB Web address
If online content is supplementary to the print book or the same as the book, please include a URL here.  If the website provides readers with unique content online, please add Online as a publication below, and pay the membership fee for that publication.
YB Facebook Handle
YB Twitter Handle
YB Instagram Handle
Other YB Social Media
 Please list name & handle.
YB Adviser Name
If you have more than one yearbook adviser, please enter them at end.
YB Adviser Email
YB Adviser Phone
YB Adviser Cell Phone
Newspaper/Newsmagazine (NP) Information
Please leave blank any questions that do not apply.
NP Publication Name
NP Type of Publication
Frequency of NP Publication
NP Web address
 If online content is the same to the print product, please include a URL here.  If the website provides readers with unique content online, please add Online as a publication below, and pay the membership fee for that publication.
NP Facebook Handle
NP Twitter Handle
NP Instagram Handle
Other NP Social Media
 Please list name & handle.
NP Adviser Name
If you have more than one newspaper/newsmagazine adviser, please enter them at end.
NP Adviser Email
NP Adviser Phone
NP Adviser Cell Phone
TV Broadcast (TV B) Information
Please leave blank any questions that do not apply.
TV B Name
TV B Channel
TV B Web Address
If online is the television broadcasts, please include a URL here.  If the website provides readers with unique content online, please add Online as a publication below, and pay the membership fee for that publication.
TV B Facebook Handle
TV B Twitter Handle
TV B Instagram Handle
Other TV B Social Media
 Please list name & handle.
TV B Adviser Name
If you have more than one TV broadcast adviser, please enter them at end.
TV B Adviser Email
TV B Adviser Phone
TV B Adviser Cell Phone
Radio Broadcast (Radio B) Information
Please leave blank any questions that do not apply.
Radio B Name
Radio B Channel
Radio B Web Address
If online content is the radio broadcasts, please include a URL here.  If the website provides readers with unique content online, please add Online as a publication below, and pay the membership fee for that publication.
Radio B Facebook Handle
Radio B Twitter Handle
Radio B Instagram Handle
Other Radio B Social Media
 Please list name & handle.
Radio B Adviser Name
If you have more than one radio broadcast adviser, please enter them at end.
Radio B Adviser Email
Radio B Adviser Phone
Radio B Adviser Cell Phone
Online News (ON) Information
Please leave blank any questions that do not apply.
ON Website Name
ON Web Address (URL)
ON Facebook Handle
ON Twitter Handle
ON Instagram Handle
Other ON Social Media
 Please list name & handle.
ON Adviser Name
If you have more than one online adviser, please enter them at end.
ON Adviser Email
ON Adviser Phone
ON Adviser Cell Phone
Additional Adviser Information
If you have more than one adviser for any of the above, please enter them here.
Additional #1 Adviser Name
What publication does he/she advise?
Check all that apply.
Additional Adviser #1 Email
Additional Adviser #1 Phone
Additional Adviser #1 Cell Phone
MEMBERSHIP AND PAYMENT METHOD
$275 = Entire School (4+ publications/programs)
$225 = 3 publications/programs
$150 = 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?
I am renewing before Sept. 1! Please subtract $10 from my membership fees!
JEA Membership $60 per adviser
Please renew your JEA membership here. MIPA will receive $5 for each membership. $60 per year for 1, 2, 3 or 4 years.
JEA Membership Adviser Name(s)
Please list the full name(s) of the advisers who are joining JEA.
Donation to Student Press Law Center
SPLC does so much for scholastic press rights. Help support them now by donating any amount (list below).
Late Fee
After Dec. 1
TOTAL AMOUNT DUE
Enter the total of your membership choices.
Payment Options
Mentor Program
If you would like a mentor or would like to work with new advisers, sign up here: http://mipajournalism.com/resources/mentor-program/ 
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 unable to submit your membership online, please email Stephanie Green at mipa@missouri.edu for assistance.

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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