Auburn Community Television
Family Lifetime Membership

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Name: _____________________________________________________________________ Address: ___________________________________________________________________ City: ______________________ State: ___________ Zip: ___________ Phone:___________________Email:_______________________________________________

$200 one-time donation

Signature: ___________________________________________ _________Date: ____________

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Your membership entitles you to special discounts on training classes and tape dubbing, access to the Community Bulletin Board and studio production opportunities and use of video production equipment as well as editing equipment. PLUS you are supporting a very worth while nonprofit cause - public access COMMUNITY television!

Please enclose cash, money order or check made payable to ACTV:
Auburn Community television
P.O. Box 818
Auburn, CA 95604

Thank you for your generous support of this important community resource.