C T A M Community Theatre Association of Michigan
Nancy Peska, Executive Secretary
4619 W. Van Buren Road
Alma, MI 48801

 [____] YES, WE want to be a NEW GROUP MEMBER of CTAM  $110 enclosed
 [____] YES, WE want to RENEW OUR GROUP MEMBERSHIP  $110 enclosed
 [____] YES, WE want to be a MEMBER of Theatre Alliance of Michigan  $25 enclosed
 [____] YES, I want to make a tax-deductible donation to the Joyce A. Schultheiss Memorial
                     Scholarship fund in the amount of $_______


Information you provide will be used in our Directory. We do not sell our Directory list to anyone. Directories are only
given to each Group and Associate Member. Members may purchase extra copies. If you do not want the information
listed in the directory, please indicate such by adding notes to the appropriate lines.

THEATRE GROUP____________________________________________________________________________________________________

Street Address_________________________________________________________________________________________________________

Mailing Address________________________________________________________________________________________________________

City State Zip__________________________________________________________________________________________________________

E-mail Address_________________________________________________________________________________________________________

Web Site_____________________________________________________________________________________________________________

Telephone ____________________________   Fax_______________________________

LAST YEAR'S SEASON: (2005-2006)____________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________

THIS YEAR'S SEASON: (2006-2007)____________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________

BOARD PRESIDENT / EXECUTIVE DIRECTOR

Name______________________________________________________________________________________________________________

Street Address________________________________________________________________________________________________________

City State Zip_________________________________________________________________________________________________________

Telephone_______________________________________Fax__________________________________

Home Office__________________________________________________________________________________________________________

E-mail_______________________________________________________________________________________________________________

Your President will be designated as a CTAM Member Delegate. Please name another
person as second Member Delegate. Click here to find out more about Member Delegates

MEMBER DELEGATE

 Name__________________________________________________________________________________________

Street Address_________________________________________________________________________________________________________

City State Zip __________________________________________________________________________________________________________

Telephone________________________________________Fax___________________________________

Home Office____________________________________________________________________________________________________________

E-mail_________________________________________________________________________________________________________________

NEWSLETTER EDITOR/ PUBLICATIONS CHAIR

Name________________________________________________________________________________________________________________

Street Address________________________________________________________________________________________________________

City State Zip___________________________________________________________________________________________________________

Telephone ________________________________________Fax___________________________________

Home Office____________________________________________________________________________________________________________

E-mail_________________________________________________________________________________________________________________:


Directories are only available to our Group and Associate Members.
If you do not want the information listed in the directory, please indicate by adding notes to the appropriate lines

Return to:
Nancy Peska
4619 W. Van Buren Rd.
Alma, MI
48801