Company Name (required)

Contact Information

Contact person, Position

Address, Contact Person

Email (required)

Phone (required)

Fax

Company Information

Address, Head Office

Email

Phone

Fax

Please include phone, email, and fax information

Website

About Your Company:

1. Year established:

2. Number of books in print:

3. How many titles did you produce in the last two years:

4. What percentage of your company is owned by Canadians?:

If less than 80%, please give details of non-Canadian shareholders:

5. Briefly describe your publishing program.

6. What percentage of books are authored by principals, directors, partners, or employees?:

7. For the past fiscal year, what percentage of your total book sales is from Canadian books?:

Applying for:

 Full Membership Associate Membership Supporting Membership

If applicable, please include a list of Chief Officers, Directors and/or Partners including name, citizenship and domicile of each.

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