General Membership Form

Manual Membership Application

Name:
Title:
Company / Organization:
Address:
City: State: Zip:
Telephone: Fax:
Email: Mobile:

Yearly Membership Fees:
(please check ONE)

Membership Type		Annual Cost:
	Individual Membership	$ 25
	Student Membership	$ 10
	Sustaining Membership	$ 100

Membership Category
(please check ONE)

U - Electric Utility	S - Supplier
G - County or City Government	AL - At Large
C - Contractor	CCS - City / County / State Hwy

TVMA's Tax ID: 76-0415282
Please COMPLETE this FORM and MAIL with Check (payable to TVMA) to:
TVMA, c/o CHB Consulting, 726 Camp Lone Star Road
La Grange TX 78945; Phone 979-968-5602 Fax: 979-968-5624
Email: ddippel@cvtv.net