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                                    THE OLDEST NEWS PHOTOGRAPHERS ASSOCIATION IN THE UNITED STATES – BOX 51477 BOSTON, MA 02205
APPLICATION FOR MEMBERSHIP (PLEASE PRINT OR TYPE) DATE
   NAME
HOME ADDRESS
CITY   STATE
EMPLOYER
ADDRESS
CITY   STATE
D.O.B.
PHONE ZIP CODE
PHONE ZIP CODE
            PLEASE CHOOSE THE TYPE OF MEMBERSHIP FOR WHICH YOU ARE APPLYING. For a despcription of membership types, please read the BPPA ByLaws found online at www.bppa.net/downloads
 ____ Full Membership _____ Honorary Membership _____ Student Membership _____ Life Membership
PROFESSIONAL REFERENCES (For full and student memebership only. Students need only one professor for reference. Full memebership applicants should include a reference with whom they have worked.)
 NAME
CONTACT INFORMATION
 AFFILIATION NAME _________________________________________ AFFLIATION
   ____________________________ CONTACT INFORMATION -____________________________________________
 IS THIS AN APPLICATION FOR REINSTATEMENT?
YES
NO
   APPLICANT’S SIGNATURE
  A CHECK FOR $60.00 PAYABLE TO BPPA MUST ACCOMPANY THIS APPLICATION
  CHECK RECEIVED MEMBERSHIP COMMITTEE BOARD OF DIRECTORS RECOMMENDED
     YES     NO
ASSOCIATE
   [ 72 ] boston press photographers association