Member, 12 months: $12. Or Sustaining, $36. Or what you can, $0 or more. $ .

Name:
Street:
City, State ZIP:	,
Telephone (Day; evening):
Email:

Date when this form is being submitted: . Newsletters: Email USPS

Additional support: Contact me / my organization(s):

ACTIVITIES (Please check your current interests):

CMA awards nominations and voting.	Meetings with media managers and public officials.
CMA television / radio show guest / host.	Newsletter / web pages articles.
CMA television / radio segment planning.	Newsletter / web pages editing / design.
Coalitions / membership development.	Print / distribute literature.
Demonstrations / boycotts participation.	Publicize CMA events / shows.
Demonstrations / boycotts planning.	Research data gathering.
Fundraising work.	Research planning and publicity.
Governing board / officer service.	Staff position applicant when funding permits.
Media monitoring.	Strategy and planning committees.
Media issues conferences / convention work.

OTHER -- Activities, media issues, coalition suggestions, comments:

Submit this form online (Note that this is done via an email with your email return address; there is no encryption for privacy.) Alternatively, print out your form using File - Print Preview. Mail your payment TO: CMA / P.O. Box 14140 / Chicago IL 60614. CMA is not yet an IRS 501(c)(3) organization. Donations are not tax-deductible. Memberships and donations are subject to acceptance by CMA's board. CMA voice mail, toll-free, is 1-866-260-7198. cma@chicagomediaaction.org. www.chicagomediaaction.org.