2012-2013 CTAM Membership Invoice
(Expires June 30, 2013)

Todays Date: _________________

Name of Member:

______________________________________________________________________________
(Name of Municipality or Access Center IF VOTING MEMBERSHIP or Individual’s Name if NON-VOTING)   

Address: ____________________________________________________

City: ________________________________________  Zip:____________

Day Phone: ___________________   Fax: _________________________

Evening Phone: (optional): ____________________

E-mail address:   _____________________________________________

Please Check Appropriate Membership Category:

   ____  Voting Membership (Organization)                            $50.00

   Person designated to cast vote on behalf of your organization

   __________________________   Their Phone Number: _____________

   ____  Non-Voting Membership (Individual)                         $37.50

   ____  Non-Voting Membership (Vendor)                              $50.00

   ____  Non-Voting Membership (Non-Profit Organization  $50.00

How did you learn about CTAM? ________________________________________________________

Please Make Check Payable To: The Community Television Association of Maine  

Print out this form , fill it out and mail to:

     The Community Television Association of Maine

P.O. Box 2124

 

South Portland, Maine 04116

 

Thank you for your support !

 

Rev. 07-04-2012

 

Click here to download this invoice as a MS Word document.