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Quincy Access Television Membership Application

In order to become a member of Quincy Access Television, a person or organization/business must provide proof of residency or organization/business address in Quincy. Individuals must also provide a photo ID for identification purposes. Address proof and photo ID can be delivered in person or by uploading a file(s) via this form.

Family memberships include up to 3 people in the same household. Organization and business membership include up to 5 individuals. Non-profit memberships may require proof of non-profit status. All memberships must be renewed annually.

All individuals, regardless of membership, must attend an "Orientation to TV" session and sign acknowledgement of receiving and agreeing to the QATV Policies and Procedures.

Membership*

Name

First Name

Last Name

Suffix

Home Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone

E-Mail Address

Photo ID Image

Please provide a photo ID for identifcation purposes

Upload requirements

Proof of Residency

Please provide proof of Quincy residency (not necessary if provided on photo ID)

Upload requirements

Organization Contact Name

First Name

Last Name

Suffix

Organization Name

Organization Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Organization Contact Phone

Organization Contact E-Mail Address

Organization Members

Business Contact Name

First Name

Last Name

Suffix

Business Contact Phone

Business Contact E-Mail Address

Business Name

Business Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Business Members

Adults In Household

Adult #2 Name

First Name

Last Name

Suffix

Adult #2 Phone

Adult #2 E-Mail Address

Adult #2 Photo ID Image

Please provide a photo ID for identifcation purposes

Upload requirements

Adult #3 Name

First Name

Last Name

Suffix

Adult #3 Phone

Adult #3 E-Mail Address

Adult #3 Photo ID Image

Please provide a photo ID for identifcation purposes

Upload requirements

QATV Policies and Procedures Agreement - By checking this box, I agree that I will abide by the rules and regulations as set forth in the Quincy Access Television policies and procedures. I must attend an "Orientation to TV" session and sign acknowledgment of receiving and agreeing to the QATV Policies and Procedures.

QATV Policies and Procedures Agreement - By checking this box, all individuals under this membership agree to abide by the rules and regulations as set forth in the Quincy Access Television policies and procedures. All individuals must attend an "Orientation to TV" session and sign acknowledgment of receiving and agreeing to the QATV Policies and Procedures.