Member Form

Member

Membership *

Individual Member - $ 25.00

Member Theatre - $ 50.00

Business Member - $ 100.00

Total Amount

I am contributing on behalf of an organization.

On Behalf Of Organization

Organization Name *

Phone (Main) *

Email (Main) *

Street Address *

City *

Postal Code *

Country *

State/Province *

Name and Address

First Name *

Last Name *

Street Address (Home)

City (Home)

State (Home)

Postal Code (Home)

Email *

Phone

Please include your theatre affiliation.

Theatre Affiliation *

Please enter any mobility, dietary, or other accommodations you may require: