Please Select One  
 
Name    
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:  
You will receive a free subscription to the Suncoast Chapter's online monthly newsletter
TUBE TALK with your membership in the Suncoast Chapter
 METHOD OF PAYMENT (Credit Card required when E-Mailing Membership Application
 
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