Individual Membership Application

I agree to the Terms and Conditions Above: *

Yes

Name: *

Street Address: *

City: *

State: *

Zip Code: *

Email Address: *

A copy of this form will be sent to your email.

Age Agreement

Are you Under 18 years of Age?: *

Yes

If you are under 18, parents or guardians must approve your application.:

By choosing the "Yes" box, your parent or guardian approves your application and the terms associated with it. This will act as a signature.

Yes

Annual Level of Support: *

LPCTV needs your help to keep our training programs going, our equipment maintained, and our channel on the air. Check one or both of the following.

Volunteer my time to help support LPCTV projects. Please contact me.

Make a contribution of $25 to LPCTV to support LPCTV’s services.

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