OBPO.CA : Membership Form

OBPO APPLICATION FOR MEMBERSHIP

ADDRESS INFORMATION:

Name of Company:
Address of chief office of business:
City:
Prov:	Ontario
Postal Code:
Telephone:
Fax:
Contact Person:
email:
incoporated under the laws of:
Date of founding:

SHARE OWNERSHIP
What percentage of the company is owned by Canadians?

If any shares are owned by non-Canadians, please describe ownership structure, voting arrangements, procedure for appointments of directors, and method for arriving at publishing decisions in an email (send to obpo@interlog.com).

ELIGIBILITY FOR GOVERNMENT PROGRAMS
Are you now eligible to participate in government programs for publishers? Yes No
If not, why not?

PUBLISHING PROGRAM
How many Canadian titles do you have in print?

How many have been published in each of the last two years?

How many have been written by principals of the company?

How many received funding from either the author or the subject of the book?

SALES DECLARATION FOR THE PURPOSE OF ASSESSING FEES

Please indicate your sales in your most recent fiscal year so that your fees level can be determined:

$0 - $250,000 (fee $432.00 + $25.92 GST = $457.92)

$250,000 - $500,000 (fee $870.00 + $52.20 GST = $922.20)

$500,000 - $2million (fee $1,290.00 + $77.40 GST = $1,367.40)

$2million + (fee $1,710.00 + $102.60 GST = $1,812.60)

DECLARATION

I affirm that (company name)
is Canadian-owned and -controlled and that all information contained herein is accurate, and agree to notify the Organization of Book Publishers of Ontario should any changes take place in the ownership or structure of the company which would affect its eligibility for membership in the OBPO.

I subscribe to the aims and objectives of the Organization of Book Publishers of Ontario.

Name: Position:

Date:

Please note: membership in the OBPO is subject to approval by current members at either a membership meeting or an annual general meeting. Page one of this application will be circulated at that meeting during the period of approval of new members; page two of this application is confidential and will be seen only by the OBPO Administrative Director and bookkeeper for billing purposes.

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