New Jersey Broadcasters Association Representing the Radio and Television Industry in the Garden State
	2010 MEMBERSHIP APPLICATION
Print this page to renew by mail This is your annual dues statement to become or maintain your status as a member of the New Jersey Broadcasters Association for 2010. Please check the appropriate category and make your checks payable to NJBA and mail to : New Jersey Broadcasters Association 348 Applegarth Road, Monroe Township, NJ 08831 Your prompt payment is appreciated and necessary in order to process your application for membership.

	STATION (s) GROSS INCOME	2010 DUES
(  )	Up to $600,000.00	$400.00
(  )	$1,000,000.00	$500.00
(  )	Between $ 1,000,000.00 & $ 2,500,000.00	$850.00
(  )	Between $ 2,500,000.00 & $ 5,000,000.00	$1,200.00
(  )	Between $ 5,000,000.00 & $10,000,000.00	$1,700.00
(  )	Between $10,000,000.00 & $20,000,000.00	$2,750.00
(  )	Between $20,000,000.00 & $30,000,000.00	$3,750.00
(  )	More than $30,000,000.00	$4,750.00
(  )	Affiliate Radio Station - NY or PA Licensed	$750.00
(  )	Affiliate TV Station - NY or PA Licensed	$1,000.00
(  )	Non-Commercial Radio Station	$300.00
(  )	Non-Commercial TV Station	$1,000.00
(  )	Associate Membership	$500.00
(  )	Educational/Communications Department	$200.00

__________________________________________________________ Station/Company/Organization Name

•Dues is used for lobbying purposes only and is not tax deductible as a normal business or  charitable expense.

•If you are renewing membership, please be sure to check the appropriate box and return this form along with your check.

•If you are a new member, we will forward the appropriate forms for you to fill out.

Credit card payments are accepted. Please charge $______________ to my AMEX / MC / VISA card. Account No.:_____________________________    Cardholder Name:____________________

Cardholder Signature:________________________________       Exp:Date: ________