Community Television Association of Maine
P.O. Box
2124 South Portland,
Maine 04116
E-mail:
[email protected]
(Membership
Expires June 30, 2004)
Name of Member:
(Name of
Municipality or Access Center IF VOTING MEMBERSHIP, Individual�s Name if
NON-VOTING)
_____________________________________________________________________
Address:
_____________________________________, Maine ______ (Zip)
Day Phone: __________ Fax:__________ Evenings (optional): __________
E-mail address(es): _________________________________________________
Please
Check Appropriate Membership Category:
____ Voting Membership (Organization)
$50.00
Person designated to cast vote on behalf of your organization:
____ Non-Voting Membership (Individual) $37.50
How
did you learn about CTAM?
_____________________________________________________
Please Make Check Payable To: The Community
Television Association of Maine
And mail with this form
to:
The
Community Television Association of Maine
P.O.
Box 2124
South
Portland, Maine 04116
Thank you for your support !