Northern Access Television Membership Application

I desire to become a member of Northern Access Television Assn Inc. In the event of my admission as a member, I agree to be bound by the rules of the Association and of the Melbourne Community Television Consortium for the time being in force.

Name First Last
Date Of Birth / DD / MM YYYY
Address
Street Address

Address Line 2

Suburb / Town

State Postcode
Home Phone
Work Phone
Mobile Phone
Fax Number
Email
Web Site
What areas of Television Production are you experenced in?
What areas of Television Production would you like further training in?
Are you a member of any other C31 Production Group? If so, which?