ACAP MEMBERSHIP APPLICATION

Highlight this entire page, print, fill out and bring it to our next meeting with your $20 check made payable to "Anna Vitale c/o ACAP"

NAME:________________________________________________________(Please print)

ADDRESS:_________________________________________Apt No.________________

STATE, CITY, ZIP CODE:__________________________________________________

E-MAIL (Please print) ______________________________________________________

TELEPHONE (Home) ______________________CELL PHONE____________________

NAME OF YOUR PROGRAM_______________________________________________

TIME, DAY AND CHANNEL_________________________________________________

ACCESS CENTER OR CABLE SYSTEM:______________________________________

WHAT SKILLS OR EXPERTISE CAN YOU OFFER ACAP?_______________________

__________________________________________________________________________

                                                WELCOME!