Please print, complete and mail or fax to:

Rancho Media, LLC
P.O. Box JG
College Station, TX 77841
Fax: (877) 637-8463 / 

Organization Name:
_______________________________________________________________________

Contact Name:
_______________________________________________________________________

Mailing Address:
_______________________________________________________________________

City/State/Zip:
_______________________________________________________________________

Phone Number:
_______________________________________________________________________

E-mail:
_______________________________________________________________________

Be sure to include documentation that shows your organization is a legally recognized not-for-profit entity.