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Contact Information (required to verify information)

      Your Name 
     Your Title 
          Phone 

Publishing Company Information:

   Company Name 
        Address 
                
           City 
 State/Province  Zip/Postal Code 
        Country 
          Phone  FAX 
 Company E-Mail 
Company WWW URL 

Publication Information: (leave blank if same
                             as publishing company)
          Title 
 Previous Title 
        Address 
                
           City 
 State/Province  Zip/Postal Code 
        Country 
          Phone  FAX 
   Title E-Mail 
  Title WWW URL 

   Publication Type:
        
   Year Established: 
               ISSN: 
               ISBN: 
   Primary Category:
        
Choose one cross-reference Category:
        

Target Audience: 
 Frequency of Issue: 
  
     Editorial Desc: (50 words or less)
       

         Total Circulation: 
   Single Copy Circulation: 
        Paid Subscriptions: 
    Controlled Circulation: 

      Circulation Audit By:ABC BPA
                            CAC CCAB
                            CVC VAC
			    Other
                            Publisher's Sworn Statement
    Circulation Audit Date: 

               Cover Price: 
         Single Copy Price: 
     Back Issue Copy Price: 

   Individual Subscription: 
Institutional Subscription: 
     Canadian Subscription: 
      Foreign Subscription: 

      Publication is Free

Accepts Advertising: 
Cover RatesOne Time
1st
2nd
3rd
4th

4ColorOne Time
Full Page
1/2 Page

Black & WhiteOne Time
Full Page
1/2 Page

Rents Mailing Lists: 

   Actives Quantity: 
    Actives Price/M: 

List Management Company: 
                Address: 
                         
             City/State: 
        Zip/Postal Code: 

Number of Pgs per Issue: 
              Trim Size:  by  
          Type of Color: 
          Type of Press: 
        Type of Binding: 
          Type of Paper: 

       Printing Company: 
                Address: 
                         
             City/State: 
                    Zip: 

Printing Contract Expires: 


Staff:
Owner:
Phone: Fax: Email:
President:
Phone: Fax: Email:
Advisor (College Press):
Phone: Fax: Email:
Editor-in-Chief:
Phone: Fax: Email:
Editor:
Phone: Fax: Email:
Managing Editor:
Phone: Fax: Email:
Publisher:
Phone: Fax: Email:
Advertising Director:
Phone: Fax: Email:
Inhouse List Manager:
Phone: Fax: Email:
Production Director:
Phone: Fax: Email:
Circulation Director:
Phone: Fax: Email:
Marketing Director:
Phone: Fax: Email:
Promotion Director:
Phone: Fax: Email:
Art Director:
Phone: Fax: Email:


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