SCTV MEMBERSHIP APPLICATION NAME _______________________________________________________ ORGANIZATION _______________________________________________________ ADDRESS _______________________________________________________ MAILING ADDRESS _______________________________________________________ CITY, STATE, ZIP _______________________________________________________ PHONE ______________(H) ______________(W) _______________(C) EMAIL _______________________________________________________ MEMBERSHIP TYPE Ο$25 Individual Membership Ο$50 Organizational Membership Ο$15 Organizational Representative (Organization must be a member) Ο$75 Family Membership (Covers 2 adults and all children under age 18 who reside at the same address) Member Signature Date _______________________________________________ If under 18, parent or guardian must sign: Parent Signature Date _______________________________________________