GCTV MEMBERSHIP APPLICATION

Member Information:

Name: ______________________________________________

Address: ___________________________________________

City/Town: _________________________________________

State: _____   Zip: _____________

Areas of Interest:
	____ Camera Operation:
		____ Studio      ____ On location
	____ Cablecast scheduling
	____ Editing
	____ Bulletin Board Computers
	____ Other
	 
Administrative Committees:
	____ Technical Equipment
	____ Membership
	____ Long Range Planning
	____ Public Relations
	____ Other
	Times and Days Available:
	_______________________________________________

GCTV Membership Category
(All Memberships expire March 30 of each year)

	____ Individual . . . . . . . . $12.00
	____ Senior (60+) . . . . . . . $ 6.00
	____ Student (18+)  . . . . . . $ 6.00
	____ Business . . . . . . . . . $15.00
	____ Family (2 voting members)  $24.00
	
	Please make checks payable to: GCTV
	Tax Deductible Contribution:  $ ___________
	            Membership Dues:  $ ___________
				
	      Total Amount Enclosed:  $ ___________

Thank you for your support!