Access Sacramento : Support Access Sacramento : Join Access Sacramento Now! : Adult Membership Form

Application Categories
New Membership:	Individual Organizational Friend of Access
Membership Renewal:	Individual Organizational Friend of Access
Series Producer or Provider:
	Individual Organizational
Applicant Information
Sacramento County Organization and Organization's Address:
	(only if you are an Organizational Member)
First Name:
Last Name:
Member Number:
Your Street Address*:
P.O. Box:	(If Applicable)
City:
State:
Zip:
Home Phone:
Work Phone:
E-Mail Address:
Date of Application:
Fax Number:
Web Page Address (URL):
Method of Payment (Must be filled in)
Cash:	$
Receipt #:
Date:

Check/M.O.:	$
Check/M.O. #:
Bank:

Charge:	$
Exp. Date:
Bank:
Type of Membership Applied For
Please check the appropriate category. Paid membership is required in order to use equipment or submit programming. All Access Sacramento equipment users and program providers must be Sacramento County residents as reflected in your photo ID.
Membership Category:	Student Membership - $20.00 copy of high school ID or college transcript/schedule is required. Senior Membership - $20.00 age 65 or older, photocopy of photo ID and proof of residency is required. Individual Membership - $30.00 photocopy of ID and proof of residency is required. Series Producer or Provider Membership - See chart for Fee $50.00 Non Profit (donation) in support of Cummunity Media. $75.00 Non Profit (donation) in support of Community Media Other Non Profit (donation) in support of Cummunity Media $50.00 For Profit (donation) in support of Community Media $75.00 For Profit (donation) in support of Community Media Other For Profit (donation) in support of Community Media
Donation Amount:	(if you specified Other Non Profit or For Profit donation above, please indicate ammount below)
Membership Activities Planned
Please check the appropriate category.
Membership Activities:	Subscriber - I wish to support Access Sacramento TV Producer - I plan to create and submit for playback a TV program or PSA using Access Sacramento's television production equipment. TV Series Producer - I plan to create and submit for playback a TV series using Access Sacramento's television production equipment. Volunteer/Crew - I wish to help crew on a television production (i.e. Camera operator) Volunteer/Crew - I wish to help out in the business or production office. TV Provider - I plan to submit a pre-recorded TV program for playback on cable channels 17 or 18. I will not be using Access Sacramento's production equipment. TV Series Provider - I plan to submit a series of pre-recorded TV programs for playback on 17 or 18. I will not be using Access Sacramento's production equipment. Radio Producer - I plan to create and submit for playback a radio program using Access Sacramento's radio production equipment. Radio Series Producer - I plan to create and submit for playback a series of radio programs using Access Sacramento's radio production equipment. Radio Provider - I plan to submit a pre-recorded radio program or a series of programs for playback on cable FM KCBL 88.7 or KRFS 89.9. I will not be using Access Sacramento's production equipment.
Fields marked with an asterisk indicate required information.

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