Online Membership Application

Please fill out as completely as possible:
* denotes required fields

Online Publication Name:

Please fill in your Publications Name.*

Web Site Address:

Please fill in your website address.*

Mailing Address:

Please fill in your mailing address.*

City:

Please fill in your city.*

State:

5 Digit Zip Code:

Please fill in your zip code.*

County:

Please fill in your county.*

Phone:

Please fill in your phone number.Please format as: (xxx) xxx-xxxx*

Fax:

Please format as: (xxx) xxx-xxxx

Staff
	NAME	E-MAIL
Publisher		Please use a properly formated e-mail address.
Editor		Please use a properly formated e-mail address.
Ad Director		Please use a properly formated e-mail address.

Please click on the box by each of the following to indicate you comply with the membership stipulation:
A:	must have been published for the previous 12-month period;
B:	must be updated no less than one time each week;
C:	must be principally devoted to the dissemination of original local or general news and other news content, with a minimum of 25 percent of overall content;
D:	must be available to the general public on the World Wide Web;
E:	must not serve primarily as a platform to promote the interest and/or opinions of a special interest group, individual or cause;
F:	must have a known Kentucky-based office of publication, open to the public, where business or publication is transacted, have a local telephone number and must include contact information in each updated publication;
G:	must abide by copyright laws

You MUST Agree to the Terms to apply for membership.
I hereby verify that all information is correct to the best of my knowledge and I agree to all terms of membership.