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For a new and renewing members.
Membership Form
Name
(Required)
First
Last
Email
(Required)
By providing your email address you consent to receiving electronic communications from SMC that are required for management of your member benefits.
Phone
By providing a telephone number and submitting this form you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging.
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
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China
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Cook Islands
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Curaçao
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Denmark
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Dominican Republic
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Virgin Islands, U.S.
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Ã…land Islands
Country
Type of Membership
(Required)
Individual
Organizational
Individual Membership Type
(Required)
Membership is tax-deductible
Somerville Resident (Adult)
Somerville Resident (over 65)
Somerville Resident (age 12-18)
Non-Resident (Adult)
Non-Resident (65+)
Non-Resident (age 12-18)
Somerville Residents: Upload your proof of Somerville residency here:
This could a utility bill, school ID, drivers license, any mail that shows your proof of residency.
Max. file size: 128 MB.
Orientation Dates
(Required)
Orientation is scheduled monthly and is required for new members.
I will attend an Orientation before accessing my member benefits..
I already attended an Orientation.
Date of Birth
(Required)
Please select your date of birth. This information helps SMC to better serve its community and submit applications for funding. It will never be used to personally identify you.
Month
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
Day
1
2
3
4
5
6
7
8
9
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11
12
13
14
15
16
17
18
19
20
21
22
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27
28
29
30
31
Year
Year
2026
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2009
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2005
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2003
2002
2001
2000
1999
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1995
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1991
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1988
1987
1986
1985
1984
1983
1982
1981
1980
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1978
1977
1976
1975
1974
1973
1972
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1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
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1945
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1942
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1939
1938
1937
1936
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1930
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1928
1927
1926
1925
1924
1923
1922
1921
1920
Gender
(Required)
Please select your gender. This information helps SMC to better serve its community and submit applications for funding. It will never be used to personally identify you.
Male
Female
Nonbinary
Other
I choose not to answer
Race
(Required)
Please select your race. This information helps SMC to better serve its community and submit applications for funding. It will never be used to personally identify you.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
I choose not to answer
Ethnicity
(Required)
Please select your ethnicity. This information helps SMC to better serve its community and submit applications for funding. It will never be used to personally identify you.
Hispanic or Latino
Not Hispanic or Latino
I choose not to answer
Adults in Household
(Required)
Please select the number of adults living in your household. This information helps SMC to better serve its community and submit applications for funding. It will never be used to personally identify you.
1
2
3
4
5
6+
I choose not to answer
Children in Household
(Required)
Please select the number of children (under 18) living in your household. This information helps SMC to better serve its community and submit applications for funding. It will never be used to personally identify you.
1
2
3
4
5
6+
I choose not to answer
Household Income
(Required)
Please select the annual total combined income range of your household. This information helps SMC to better serve its community and submit applications for funding. It will never be used to personally identify you.
Under $25,000
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
100,000 - $149,999
$150,000 - $199,999
$200,000 and above
I choose not to answer
Household Primary Language
(Required)
Please select the primary language spoken in your household. This information helps SMC to better serve its community and submit applications for funding. It will never be used to personally identify you.
Amharic
Arabic
Chinese (Cantonese)
Chinese (Mandarin)
English
French
Haitian Creole
Italian
Korean
Portuguese
Russian
Spanish
Tagalog
Vietnamese
Other
I choose not to answer
Do you have any other skills/hobbies you would like to share with us?
Computer Graphics / Programming
Teaching / Education
Photography
Community Organizing
Non-Profit Management
Radio
Carpentry / Set Design
Drawing / Painting
Creative Writing
Electrical / Engineering
Community Media
Filmmaking
Organization Name
(Required)
Enter the complete legal business name or D.B.A. name of the organization.
Organization's Annual Operating Budget
(Required)
Up to $150,000
$150,000-$300,000
$300,000-$500,000
$500,000-$1M
$1M+
Organization's Primary Service Area
(Required)
Please enter the primary service area for your organization
Arlington
Belmont
Boston
Cambridge
Chelsea
Malden
Medford
Somerville
Watertown
Other
Organization's Mission Statement
(Required)
Please enter your organization's mission statement here
What types of projects would you like to work on at SMC?
What is one thing you like about Community Media?
Agreement to Policies and Procedures
(Required)
All users of SMC's resources are subject to the Policies and Procedures. Please enter your name here once you have read and understand the policies linked here: https://docs.google.com/document/d/1zbzc972nQTaWVntKb2feF7upsh-sV-paKj9Gh9nykCI/edit?usp=sharing
Amount Due
Payment Type
(Required)
Credit Card
Mail Check
Hand deliver to 29 Properzi Way
Credit Card
(Required)
Card Details
Cardholder Name
Please deliver or mail your payment to:
Somerville Media Center
29 Properzi Way
Somerville, MA 02143
Your membership will become active when we receive your payment.
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