CMA Membership Form

NOTE! This page is a nonworking, nonapproved draft! 2003 09 08

You can mail this information to: CMA / PO Box zzzzzzzz / zzzzzzzzz, IL 60nnn. Phone: (zzz) zzz-zzzz

Member. Dues. (One year. $10, or other, $1 minimum.) $________. Activities: Please do not forget to check below the activities in which you are especially interested.
Advisor/Affiliate. For media corporation professionals, a possible apparent conflict, who want to offer financial support, counsel, or volunteer work to CMA. Nonvoting and not eligible for CMA elected positions. Public statements of your professional interests will be requested. $30 quarterly minimum. $_________.
Newsletter delivery preferrence: Email USPS Both.
Additional support donation, $________.
Issues coalitions: Contact my organization(s):
Contact me/my organization(s) about other support:
Chicago Media Action tee shirts. Sizes (M, L, XL, XXL) ________. Total, at $15, including U.S. postage and handling: $_______.

Name:
Address:
City/State/Zip:
Telephone (Day? Evening?):
Email:
Date of above information:

Additional comments:

Memberships, donations, and affiliations are subject to acceptance by the CMA Executive Committee. CMA is an IRS 501(c)3 organization, so donations are tax-deductible to the extent allowed by law. For current information, see the CMA web site, www.chicagomediaaction.org .

Activities (Please check your interests): Demonstrations and boycotts planning ....... Demonstrations and boycotts participation ....... CMA Awards nominations and voting ....... Organization responsibility: Strategy and planning committees ....... Organization responsibility: Governing board and officer service ....... Membership development outreach work ....... Work at events ....... Research planning ....... Research data gathering and media monitoring ....... Planning and circulating petitions ....... Convention / media issues conferences / seminars work ....... Newsletter editing / submissions / design ....... Web site editing / submissions / design ....... Essays, columns, letters to editors ....... Fundraisers work ....... CMA television / radio show segments planning and producing ....... CMA television / radio show guest ....... Publicizing and promoting CMA events and shows ....... OTHER: