MEMBERSHIP APPLICATION FORM
 

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Primary Phone: *	(enter as xxx-xxx-xxxx)
Alternate Phone:	(enter as xxx-xxx-xxxx)
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Are you Spanish speaking?	No Yes
Each year, NTA members are asked to sit on one or more panels to judge Emmy entries for other chapters. Are you willing to help judge entries from other EMMY chapters?
Judge?	No Yes
Market: *	-select- Abilene Amarillo Austin Beaumont/Port Aurthur Corpus Christi Dallas/Fort Worth El Paso Houston Laredo Lubbock Midland/Odessa/Rio Grande Valley San Angelo San Antonio Sherman/Denison Tyler/Longview/Lufkin Waco/Temple/Killeen Wichita Falls Victoria Other
Please Select a Membership Type: *	-select- Professional $65 Associate $65 Student $35
Payment Method:	Credit Card Check If paying by check, please select submit at bottom of page. Instuctions to follow.
Billing Information for Online Credit Card Payments (All required for Payment Method of Credit Card)
Credit Card Type:	-select- Visa MasterCard
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Expiration Date:	-- 01 02 03 04 05 06 07 08 09 10 11 12 ---- 2008 2009 2010 2011 2012 2013 2014 2015
Credit Card Verification Number:	3 digit number on the back of the card in the signature line
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I hereby apply for membership in the Lone Star Chapter of the National Television Academy and agree to abide by all the rules and regulations as provided in the National and Chapter constitutions and by-laws.
* Fields marked with an asterisk are required.

Active Membership

Active Membership is offered to those employed in the television or related industries who make specific contributions to the industry, including executives, technicians, writers, directors, photographers, producers, performers, etc.

Associate Membership

Associate Membership is offered to those interested in and supportive of the advancement of television, but who cannot be classified in the above professional category.

Student Membership

Student Membership is offered to full-time students active in the learning side of television, including elementary, high school, college, university, graduate and trade organizations within the Lone Star region.