Application for Membership in American Association of Internet Journalists

Name:

Address:

City:

State:

Phone: (        )

E-Mail Address:

IP address of web site were maintained by applicant:

IP address of web site(s) where applicant’s writing can be viewed:

Please identify any books you have written:

Please check categories which best describe the type of site hosted by you, or field of journalism in which most of your writing would fit.

1) News  ____ 2) Opinion ____  3)  Educational ____ 4) Government ____ 

5) Law & Justice ____

6) Partisan politics officially related to or sponsored by a political party or candidate ____

7) Religion ______ 8) Business ______ 9) Social _____10) Entertainment _____

11) Other, please describe:

Are you currently employed by a political party or by a candidate for public office: Yes___No___

Are you currently a candidate for public office? Yes ___  No___

Are you a licensed lobbyist? Yes ___ No___,

If answer is Yes, please name the organization for whom you lobby:

Your age: _____

Highest level of education completed:

High School __ College___ Professional or Graduate School ___

I have read, and agree to be bound by the terms of membership, including the limitations of liability, and to ascribe to the Code of Ethics of the American Association of Internet Journalists.

Yes____   No ____

Your signature:_________________________________________________________

Please mail application to AAIJ, 314 7^th. St. Carrollton, Ky. 41008 with your check for $25.  The membership committee will promptly notify your acceptance or rejection for membership.