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Please print and mail to the address below. 

Feel free to use the reverse side of your print-out to supply additional information that doesn't fit within the lines of the form.


Name of Person Filing the Application: (Mr./ Mrs./ Miss) ______________________________________________  

Please check one: ____Organization ___Individual         Date: ______________

Contact information for CMC use only:

Home Address: _______________________________________________________________________

Home Phone: _______________________________ Home Fax: _____________________

E-Mail Address (Where do you want your CMC e-mail correspondence sent?) ______________________________

Organization /Individual information to be listed on the CMC web site for public viewing
(If you are NOT an organization please provide only individual information that can be made public.)

(Arch) Diocese: ________________________________________________________________________

(Arch) Bishop: _________________________________________________________________________

Organizationís (Individualís) Name: ______________________________________________________

Organizationís (Individualís) Address: ____________________________________________________  

Organization's (Individual's) E-mail Address (if any):  _____________________________________________________

Organizationís (Individualís) Phone (if any): _______________________________________________

Organizationís (Individualís) Fax (if any): _________________________________________________

Website Address (if any): _______________________________________________________________

Publication / Newsletters (if any): _________________________________________________________

Information helpful to us

Title(s) of Position(s) You Hold (if any): ___________________________________________________

Please list main Catholic activities and/or Catholic organizations of which you are a member:


Please state how you learned about the CMC:  ________________________________________________________

Names of current CMC members who could provide a reference if any: _____________________________________

Name of Additional Members: ________________________________________________________________________________

Home Address: ________________________________________________________________________
Home Phone: ______________________________ Home Fax: ________________________________
E-Mail Address: ______________________________________

Name of Additional Members: ________________________________________________________________________________

Home Address: ________________________________________________________________________
Home Phone: ______________________________ Home Fax: ________________________________
E-Mail Address: ______________________________________

Each person who becomes a member of CMC should understand that the organization is fully committed to the orthodox teachings of the Catholic Church, as proclaimed by the Magisterium.  It is expected that all CMC members accept the Magisterium as the authoritative teacher of the Catholic Faith, and assent to all it teaches.  

On reverse side of this print-out, please include private contact information for any additional members (beyond the first 3) from your organization joining CMC.  The person filing the application plus 2 additional members are included under your organizationís membership fee.  Each member beyond the first 3 costs an additional $12/year. (See Membership Agreement Ė#5 Dues)

The Membership Agreement must also be printed out and signed by the person making the application. Mail everything to:

Catholic Media Coalition Membership

4877 S. Meadow Ridge Dr.

Green Valley, AZ 85614


For Office Use Only:  Is this a renewal?  Y/N______

Dues Paid:  Organization _______  Individual _______  Date Entered _________  Notes: ______________________

If you have any questions about the Membership Procedure, please email  webmaster@catholicmediacoalition.org