NEWTON COMMUNICATIONS ACCESS CENTER, Inc.
Membership Application Form

NewTV may give my name and phone number to community producers for crew calls.
* Required
Last Name*	First Name*	MI
Address*		Apt
Village*	ZIP*	Email*
	-
Home Phone*	Work Phone	Fax
I watch public access TV *	--Select one-- more than once a week once a week less than once a month never
I heard about access from *	--Select one-- newspapers/radio/TV access channels friend other
My age is	-- Optional -- under 18 18-25 26-34 35-44 45-54 55-65 more than 65
My annual income (in thousands) is	-- Optional -- under 10 10-15 15-20 21-30 31-45 over 45
Ethnic group	-- Optional -- English French German Spanish other