Student Television Network Membership Form

Please complete all fields, then click the "Submit Membership Form" button at the bottom of the page.

Chose the membership level that best suits your organization. For scholastic broadcasters, chose "Affiliate" from the pulldown list below:



 

Part I: Affiliate Information
   School/Organization Name: 
   Address:                  
                             
   City:                     
   State:                    
   Zip code:                 
   Main Phone (no dashes):   
   Main Fax (no dashes):     



Part II: Affiliate Contact Information
   Your name:                             
   Your email:                            
   Direct phone (no dashes):              

Your invoice and receipt will be sent to the address specified above.
If we have questions, we will call the direct phone number supplied.

   Email address to which you would like
   the monthly STN newsletter to be sent: 

   Is your school a Channel One School?   Yes  No



Part III: Identification
   The name of your program (i.e. "Bulldog News," etc)
   (Note: We can only list one program name on
   our online membership list.  If your school
   produces more than one program, please enter
   the one you would like listed):                   

   Your program web site, if available (if you
   have a web page within your school web site,
   please list the EXACT URL that will get to your
   actual page):                            http://