Mr. Mrs. Ms. (Please Click one) Type Full Name Name of Member who is recommending this applicant Street address where you wish to receive mail    City                                                                                         State                              Zip    Home Phone                                                                        Office Phone    Cell Phone                                                                                      E-Mail IF YOU WORK: What is the name of  your Employer ?                                                                                           What is your Title ? IF YOU ARE A STUDENT: Name of  your college or university                                                                                              Major/Minor

ACTIVE or ASSOCIATE

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ACTIVE: You are professionally engaged in television. ASSOCIATE: You are interested in the advancement of the arts and science of television.

Annual membership rates for Active and Associate members: Click the rate that applies to you.

ALABAMA     FLORIDA        Mobile       new Member $35.00 renewal $25.00 Naples - Ft, Myers new Member $35.00  renewal $25.00 GEORGIA     Miami - Ft. Lauderdale new Member $60.00 renewal $50.00 Thomasville       new Member $30.00 renewal $20.00 Gainesville new Member $30.00 renewal $20.00 LOUISIANA     Jacksonville new Member $30.00 renewal $20.00 Alexandria new Member $30.00 renewal $20.00 Orlando-Daytona Beach new Member $50.00 renewal $40.00 Baton Rouge new Member $35.00 renewal $25.00 Panama City new Member $30.00 renewal $20.00        Lafayette new Member $30.00 renewal $20.00 Pensacola new Member $35.00 renewal $25.00 Lake Charles new Member $30.00 renewal $20.00        Sarasota      new Member $50.00 renewal $40.00 New Orleans new Member $45.00 renewal $35.00 Tallahassee new Member $30.00 renewal $20.00 PUERTO RICO     Tampa-St. Petersburg new Member $50.00 renewal $40.00 All markets new Member $50.00 renewal $40.00 West Palm Beach new Member $60.00 renewal $50.00

Annual membership rates for Students: Click the rate that applies to you.

new Member $15.00 renewal $15.00

         

                            

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                                                                  Master Card Visa

               Credit Card Number

                      Expiration Date MMYYYY

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