Florida Cable Telecommunications Association
246 East 6th Avenue • Tallahassee, Florida 32303 • (850) 681-1990 • FAX (850) 681-9676

Application for Associate Membership

The undersigned hereby applies for Associate membership privileges in the Florida Cable Telecommunications Association, Inc., a trade association organized under the laws of the State of Florida as a non-profit corporation.

Applicant certifies to being engaged in the manufacture or distribution of equipment, materials, or services used by the cable telecommunications industry, or otherwise involved in the cable telecommunications industry, and does hereby agree to subscribe to and abide by the By-Laws of the Association as exist now or as may be duly amended from time to time.

To become effective upon approval by the FCTA Board of Directors.

Firm Name ____________________________________________________________________

Parent Company ________________________________________________________________

Individual & Title _______________________________________________________________

Mailing Address ________________________________________________________________

City, State & Zip ________________________________________________________________

Telephone & FAX _______________________________________________________________

Website & Email Address _________________________________________________________

Description of Product or Services
(This will appear in the FCTA Annual Directory & Desk Guide)

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* Associate Membership applies to the applicant company and not to the identified representative.

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