Membership Form
Name
*
First Name
Last Name
Station
*
Program/ Show
*
Language
*
Is this a Woman's/ Youth Show? (Please state which one or write NO if it's not)
*
Email
*
example@example.com
Presenters
First Name
Last Name
Presenters
First Name
Last Name
Presenters
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Signature
How did you first hear about the NEMBC?
What services or resources would you like to see the NEMBC offer more of?
Are there any specific issues or challenges facing your organisation that you would like the NEMBC to address?
Please share any other thoughts or suggestions you may have for the NEMBC.
Submit
Submit
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