Membership Application
Annual Membership $100.00 per Channel

* Indicates a Required Field
Station Name:*
Type of Station:

Towns Served By This Station:
Address:
City:

State:

 Zip:
Contact Name:*
Phone Number:* Ext.
Fax Number:
E-mail Address:*
Web Address:
Total Number of Subscribers in Municipality:

Cable Company/Provider:
Year Station Originated:
Franchise Renewal Date:
Station Employees:
Name Title
Annual Budget - Operations:
Salary and Wages:

Number of Volunteers: Hours Per Week Cablecasting:

Number of Programs Produced Annually :

Cablecast Format:
VHS
SVHS
MiniDV
DVPRO
DVCAM
DVD
Server (file-based playback)
Other:

 

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