Please Select One  
Name   Member who is recommending this Applicant
Street Address where you wish to receive mail           
City   State Zip Code
Home Phone   Office Phone  
Cell Phone E-Mail Address  
IF YOU WORK:
Name of Employer Job Title
IF YOU ARE A STUDENT:
Name of College or University Major/minor
You may apply for one of the following classes of annual Membership: PLEASE SELECT ONE  
ACTIVE: You are a Professional engaged in television. ASSOICATE: You are interested in the Advancement of the Arts and Sience of  Television
Annual membership rates for ACTIVE and ASSOCIATE members: (rates have been adjusted to reflect market size) 
ALABAMA     FLORIDA       
Mobile $35.00 $25.00 Naples - Ft, Myers $35.00 $25.00
GEORGIA     Miami - Ft. Lauderdale $60.00 $50.00
Thomasville $30.00 $20.00 Gainesville $30.00 $20.00
LOUISIANA     Jacksonville $45.00 $35.00
Alexandria   $30.00 $20.00 Orlando-Daytona Beach $50.00 $40.00
Baton Rouge $35.00 $25.00 Panama City $30.00 $20.00
Lafayette $30.00 $20.00 Pensacola $35.00 $25.00
Lake Charles $30.00 $20.00 Sarasota $50.00 $40.00
New Orleans $45.00 $35.00 Tallahassee $30.00 $20.00
PUERTO RICO     Tampa-St. Petersburg $50.00 $40.00
All markets $50.00 $40.00 West Palm Beach $60.00 $50.00
           
Annual membership rates for Students: Click the rate that applies to you.  
$15.00 $15.00
Amount paid:  
Subscribe to Suncoast Chapter News Letter Tubetalk?
 METHOD OF PAYMENT
Address as it appears on billing statement for credit card, if applicable  
Name
Billing address of this credit card
City         State Zip
Card Number Expiration Date