Community Theater Membership (Voting) Application

(Enter 'Pending' or 'NA' in fields where information is not yet available)

Theater Name:____________________________________________
Theater Venue: ___________________________________________
Theater Street Address: ____________________________________
Theater City, State, Zip: ____________________________________
Theater Phone: ___________________________________________
Theater E-mail: ___________________________________________
Contact Person:

__________________________________________

Contact Address: _________________________________________
Contact City, State, Zip: ____________________________________
Contact Phone: ___________________________________________
(Required) Contact E-mail: __________________________________

Two Member Names for MeACT Board of Directors:
(All fields required)

Name: __________________________________________________
Street Address: ___________________________________________
City, State, Zip: ___________________________________________
Phone: _________________________________________________
Email: _________________________________________________
Name: __________________________________________________
Street Address: ___________________________________________
City, State, Zip: ___________________________________________
Phone: _________________________________________________
Email: _________________________________________________
Your membership will be dated as of the date we receive your check for $30
Annual Theater Membership Dues. Make check payable to: Maine
Association of Community Theaters, P. O. Box 489, Monmouth, ME 04259

 
MeACT Individual Membership (Non-voting)
(Enter 'Pending' or 'NA' in fields where information is not yet available.)

Name: __________________________________________________
Street Address: ___________________________________________
City, State, Zip: ___________________________________________
Phone: _________________________________________________
(Required) Email __________________________________________
Your membership will be dated as of the date we receive your check for $12 Annual Individual
Membership Dues. Make check payable to: Maine Association of Community Theaters, P. O. Box 489,
Monmouth, ME 04259

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