Email Address

Company email addresses only. Generic emails may not be approved.

Password

Confirm Password

Password requirements: A minimum of eight (8) characters, containing at least three (3) of these criteria: an uppercase letter; a lowercase letter; a number; a special character.

First Name

Last Name

Work Phone

Company

Publication/Media Type Select One Other - Please specify below Internet based Magazine Newspaper Radio Television

If other or CBS, please specify

TCA Member

Job Title Select One Blogger Critic Contractor Editor Graphic Artist/Designer Photo Editor Producer Program Licensee Reporter Other

Address

City

State/Province Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Alberta Bristish Colombia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Ontario Prince Edouard Island Quebec Saskatchewan Yukon Territory Nunavut

Country

Zip code

Supervisor's Name

Supervisor's Phone

Additional Notes (optional)