Raymond Community Television Raymond, NH

4 Epping St. Raymond, NH 03077 603-895-6405 www.raymondtv.org

RCTV Membership Form
Form RCTV-1

By signing below, I hereby acknowledge that I have read and fully understand the rules described in the Raymond Community Television PEG Access Policies, and agree to abide by those rules or face disciplinary action as described.

I understand that when representing myself as a member of Raymond Community Television that I will abide by the established code of conduct, and that I am personally responsible for the content contained in programs that I produce and/or sponsor for RCTV.

Full Name
Address
Home Phone
Work Phone	Cell Phone
E-Mail
Signature	Date

If producing a program, RCTV requires a contact number which will be given upon request regarding inquiries about said program.

Please indicate the number above which you would like to make available for this purpose:_______________________

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