2010-2011 CTAM Membership Invoice
(Expires June 30, 2011)

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. 07-08-10

 

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