Please print out this page, fill out the form and mail it and to :

2005-2006 CTAM Membership Invoice
(Expires June 30, 2006)

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

_________________________________________

Address: _____________________________________, City: ______ Zip:_______

Day Phone: __________   Fax:__________   Evenings (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

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 !