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.

Name
Home Address
Phone
Please provide a photo ID for identifcation purposes
Upload requirements
Please provide proof of Quincy residency (not necessary if provided on photo ID)
Upload requirements
Organization Contact Name
Organization Address
Business Contact Name
Business Address
Adult #2 Name
Adult #2 Phone
Please provide a photo ID for identifcation purposes
Upload requirements
Adult #3 Name
Adult #3 Phone
Please provide a photo ID for identifcation purposes
Upload requirements