NEW! Now you can join ACC free for 6 months. Take a “test drive” with ACC and after 6 months you will only be billed for the remaining 6 months of the year, or $100. Or just write cancel on your invoice and return it to ACC and you won’t owe us a thing! Just return the application below, no payment is needed for your first 6 months!

Applicant Information:

Please Choose One:
Mr.    Ms.    Dr.   

________________________________________________________________
Name

________________________________________________________________
Title

________________________________________________________________
Company

________________________________________________________________
Street Address

________________________________________________________________
City                                          State                                           ZIP

________________________________________________________________
Phone Number                       Fax Number                              Email

Number of years in the industry _______________
How did you hear about ACC?

FORUM Beacon Awards Web Site

Referred By: ___________________ Other: ___________________

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Company Type:

Cable Network
Cable Company; Number of Customers: ___________________
State or Regional Association
Equipment Manufacturer
Consultant/ Public Relations Firm
Other: ____________________________________

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Occupational Emphasis

please limit your choice to three

Affiliate Relation/Sales Community Relations Education Financial

Government Relations Marketing Operations Production

Programmer Public Relations Other: _____________________

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Payment

Pay nothing for your first 6 months of membership. After 6 months you will only be billed for the remaining 6 months of the year, or $100. You can also choose to cancel and owe ACC nothing after 6 months.

Please mail completed application to ACC at:
P.O. Box 75007, Washington, DC 20013-5007,
Attn: Membership Services Coordinator.

Membership is not transferable. Membership services will begin in 2-3 weeks after receipt of this application. If you prefer to pay for your annual membership now, please include a check for $100 or the credit card information below. Your membership in ACC will be valid for one year. A year from now, you will receive a renewal notice at the regular individual membership rate.

Check Visa Mastercard American Express

Name on Card: ________________________ Card #: ________________________ Exp. Date: ________________________ Authorized Amount: ________________________