SYSTEM MEMBER is any individual, partnership, association or corporation engaged in the business of providing television reception and other communication services for the public by means of cable television system either for an operating cable television system or a valid franchise authorized to construct a cable television system.

Individual or corporations owning or controlling several Indiana systems may combine the total number of customers in all systems to determine the annual dues rate. When more than one Indiana system is owned or controlled by an individual, firm or corporation, all such systems must be enrolled in ICTA membership.

SYSTEM MEMBER DUES

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:

Primary Contact:

Title:

E-mail Address:

Independent:

MSO:

Name of Parent MSO**:

Number of Customers:

** Please include a complete listing of Indiana cities/townships served,
including names/addresses for system/regional managers and customer counts.