2016-2017 CTAM Membership Invoice
(Expires June 30, 2017)
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: _________________________
Contact Name: ______________________________ Contact Title: ___________________________________
Evening Phone: (optional): ____________________ WEBSITE: _____________________________________
Member E-mail: _____________________________ Contact E-Mail ___________________________________
Please Check Appropriate Membership Category:
____ Voting Membership (Organization) $50.00
Person designated to cast vote on behalf of your organization
__________________________ Their Phone Number: _____________ E-Mail: __________________________________
____ 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
207 775-2900 x210
Thank you for your support !
Rev. 4/29/16
You may download this invoice in MS Word or as a PDF file.