|
FOR OFFICE USE ONLY
Date Received: ____________________ PAID: _____ CASH _____ CHECK _____ INITIALS: _______ ID: _____________ |
||||||||
| TVACCESS21 Charlotte Mecklenburg Public Access Corp. 613 Calvert Street • Charlotte, North Carolina 28208 704-377-8988 |
||||||||
|
|
||||||||
CMPAC Registration Form Please Print All Information Name: __________________________________________________________________ Current Residential Address: ________________________________________________ City: ____________________________ State: __________ Zip: ___________________ Phone: (Day) __________________________ (Evening) _________________________ E-mail: _________________________________________________________________ Mailing Address (If different from above): _____________________________________ City: ____________________________ State: __________ Zip: ___________________ I have read and understand the Rules and Regulations of the Charlotte Mecklenburg Public Access Corporation, and agree to abide by them. Signature: _______________________________________ Date: __________________ Parent/Guardian Signature: __________________________________ Date: __________ * YOU MUST BE AT LEAST 16 YEARS OLD TO REGISTER AT CMPAC. THOSE UNDER 18 MUST HAVE ADULT SUPERVISION WHILE AT THE FACILITY, AND PARENT OR GUARDIAN MUST SIGN ABOVE. • There is a registration fee of $25 for all residents of the city of Charlotte. • There is a registration fee of $65 for all residents outside the city of Charlotte, but within Mecklenburg County. • There is a registration fee of $100 for non-county residents; however, such persons may not produce programming for Access 21, but may volunteer on production crews and attend any training workshops. • Fees must be submitted in person with the registration application. • Fees must be paid in cash or personal check containing the registrant’s legal address. • All registrants are required to provide a valid government issued form of identification containing the registrant’s current residential address (e.g. driver’s license or state identification card). |
||||||||