Film Association Membership Application

Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Residential Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Date of Birth

Date

Current Occupation

Professional Experience in Film (Please describe your relevant experience, roles, or affiliations)

Areas of Interest in Film (Select all that apply)

Type of Membership Requested

How did you hear about the Film Association?

Please provide a reference or referral (if applicable)

Signature (Please sign to confirm your application)