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Membership Application

2018-2019 CTAM Membership Invoice
(Expires June 30, 2019)

Todays Date: _________________

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

Address: __________________________________________________________________________________ 

City:
_____________________________________________________  State: __________  Zip:____________

Day Phone: _____________________________   E-Mail: ___________________________________________

Cell/Alt Phone: __________________________  Website: __________________________________________

Contact Name: __________________________________  Title: _____________________________________

Contact Phone:   _________________________  Contact E-Mail: ____________________________________

Please Check Appropriate Membership Category:

   ____  Voting Membership (Town/Station)                           $50.00

   Person designated to cast vote on behalf of your organization

   Name: _________________________________________   Title : ___________________________________  

   E-Mail: __________________________________________________  Phone: _________________________

   ____  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

516 Congress Street 

 

Portland, Maine 04101

 

Email: info@ctamaine.org


Phone: 207 775-2900 x210

 

Thank you for your support !

 

Rev. 4/20/18

You may download/print this invoice as a PDF file. 

Contact Us

Community Television
Association of Maine
516 Congress Street
Portland, ME 04101
Phone: (207) 775-2900 x210
FAX: (207) 761-2559

E-Mail: info@ctamaine.org

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