New England Independent Booksellers Association
2005-2006 Membership Form

NEIBA's membership year runs from July 1, 2005 to June 30, 2006. Yearly Membership is $75. Please confirm that all the information below is accurate and return this form with your check, payable to NEIBA.
For Office Use:
Date Rcvd ___________
Check # ___________
Amount ___________
1. Membership Information
Member Name ____________________________________________
Business Name ____________________________________________
Mailing Address ____________________________________________
City/State/ZIP ____________________________________________
Telephone/Fax ____________________________________________
E-mail Address ____________________________________________
___ Please do NOT subscribe this address to NEIBA's free members-only listserv
Website ____________________________________________
Additional Member ____________________________________________
Additional Newsletter ____________________________________________
>> Additional Members ($75 each) or newsletters for members ($7.50 each) at the above address only
Membership Category
[check one]
___ Bookstore
___ College Bookstore
___ Internet (only) Bookstore
___ Mail Order (only) Bookstore
___ Museum Bookstore
___ Prospective Bookseller
___ Sales Representative
___ Wholesaler
___ Publisher
___ Other Vendor
___ Service Company
___ Other: _____________________
 

Please check whether you are a

___ General Bookstore

___ Specialty Bookstore
If you are a General Bookstore, please list up to 3 areas of concentration:
1. ___________________________
2. ___________________________
3. ___________________________
If you are a Specialty Bookstore, please check one:
___ Antiquarian
___ Arts/History
___ Children's
___ Feminist
___ Gay/Lesbian
___ Marine/Nautical
___ Metaphysics/Recovery
___ Mystery
___ Nature/Science
___ Religion
___ Science Fiction
___ Technical
___ Travel
___ Used Books
___ Other: ____________________
2. 2003 Bookstore Member Directory Information
Sq. Ft. Selling Space _____________________
Independent, # of stores _____________________
Chain, # of stores _____________________
Computer Inventory Control System? ______ Yes ______ No
If yes, what kind? ____________________________
Years in business? ____________________________
Do you sell used books? ______ Yes ______ No
If yes, what kind? ____________________________
If yes, what percent are used of total sales? ____________________________
ABA Book Sense store? ______ Yes ______ No
To help bookstore members find and network with others similar to themselves, please supply as much information as possible.
3. Holiday Catalog Listing
______ Please do NOT list my store in the Holiday Catalog.
______ Please list me as "A Children's Bookstore"
Your dues payment must be postmarked by July 31, 2004 for your store name, city, state and phone number to be listed in the Holiday Catalog. All bookstores will be listed unless unless indicated otherwise above. If you wish your store to be listed differently from the information under "Membership Information," please complete the following:
Store Name: _____________________________________
City: _____________________________________
State: _____________________________________
Phone: _____________________________________
4. Dues
____ (number of members) multiplied by $70.00 $____________
____ additional newsletter subscriptions for members, at $7.50 each $____________
____ I would like to contribute $5.00 to The American Booksellers Foundation for Free Expression $____________
____ I'd rather not join NEIBA, but will subscribe to the bi-monthly NEIBA newsletter, $20.00 $____________
TOTAL DUE: $____________
   

Please return this completed membership form with your check payable to:

NEIBA
1770 Massachusetts Avenue #332
Cambridge, MA 02140.

If you have any questions, please call 617-576-3070 or 800-466-8711.

Contributions or gifts to New England Independent Booksellers Association are not tax deductible as charitable deductions. However, they may be tax deductible as ordinary and necessary business expenses.