ASSOCIATE MEMBERS include cable television equipment manufacturers
and suppliers, consultants, management services, brokers, or any
organization with a bona fide interest in cable television.

Please contact Maddison Klontz at (317) 237-2288 to receive current dues rates.

I/we hereby apply for membership in the Indiana Cable Telecommunications
Association and agree to comply with the Bylaws, Code of Regulations
and such other rules as may be adopted.

Company:

Address 1:

Address 2:

City:

State:

Zip Code:

Telephone:

Fax:

Internet URL:

Note: If all representatives are at the above location, you may leave the address boxes below blank.

Primary Contact:

Title:

E-mail Address:

Direct Phone Number/Extension:

Address 1:

Address 2:

City:

State:

Zip Code:

Second Representative:

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E-mail Address:

Direct Phone Number/Extension:

Address 1:

Address 2:

City:

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Zip Code:

Third Representative:

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E-mail Address:

Direct Phone Number/Extension:

Address 1:

Address 2:

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Please give a brief description of the services/products your company offers (50 words or less):

How did you hear about the ICTA? (Check all that apply)
 ICTA Website
 A different website
 ICTA Member
 ICTA Mailing
 Trade Magazine
 Recommended by a colleague/friend
Other:

Person to contact regarding this application:
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