Television Membership Application

If renewing membership with no changes to station information (i.e. staff, logo, etc.) you do not need to fill out the form below.

Click the “Pay Membership Dues” button below to process a credit card or mail a check to the remittance address below.

Colorado Broadcasters Association
10488 W. Centennial Rd
Suite 405
Littleton, CO 80127

If applying as a new member or updating station information, please fill out and submit the form below. A separate form for each individual station is required. An opportunity to make payment will be presented after submitting the form.

Use the button below to see the Membership Dues Scale.

Television Dues Scale

LICENSEE INFORMATION

Licensee Name(Required)

Licensee Phone(Required)

Licensee Email(Required)

Licensee Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

STATION INFORMATION

Call Letters(Required)

Channel(Required)

Network(Required)

Station Phone(Required)

Station Email(Required)

Station Website(Required)

Upload Station Logo

Accepted file types: jpg, gif, png, Max. file size: 32 MB.

STAFF INFORMATION

Station Manager(Required)

First Last

Station Manager Email(Required)

Sales Manager

First Last

Sales Manager Email

Operations/Program Director

First Last

Operations/Program Director Email

News Director

First Last

News Director Email

Engineer

First Last

Engineer Email

Traffic Director

First Last

Traffic Director Email

Additional Staff

First, Last Name

Title

Email

Please add any additional staff using the "+" button below to add additional lines.

CONTACT INFORMATION

please provide your information should we need to contact you with any additional questions.

Contact Name(Required)

First Last

Contact Phone(Required)

Contact Email(Required)

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Television Membership Application

Renewing

Remittance Address

NEW MEMBERSHIP APPLICATION