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RequiredFirst Name
RequiredLast Name
RequiredYear of Birth
What Company are you with?
Your Title/Position
; Can we publish your phone number to Members and employers? Y/N
RequiredEmail Publish
RequiredPhone
; Can we publish this Phone number to Members and Employers? Y/N
RequiredPhone Publish
Phone 2
Cell Phone
Address Line 1
Address Line 2
; Can we publish your address to Members and Employers? Y/N
RequiredAddress Publish
RequiredCity
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Fax
Your Website URL
; What is your primary Industry job?
RequiredPrimary Job in the Industry
; List one produced title where you received credit in that job
Primary Job: Title of First Credit
; What year was this project produced?
Year of Production
; Primary Job: distributor
Distributor
; Primary Job: Type of production
What type of production was this? (short, feature, TV, etc)
; Primary Job: 2nd Credit
Primary Job: Title of a 2nd credit
; Primary Job: 2nd Credit year
Year of Production
; Primary Job: 2nd Credit distributor
Distributor
; Primary Job: 2nd Credit type
Type of Production
; Primary Job: 3rd Credit
Primary Job: Title of a 3rd credit
; Primary Job: 3rd Credit year
Year of Production
; Primary Job: 3rd Credit distributor
Distributor
; Primary Job: 3rd Credit type
Type of Production
; What is your secondary job in the Industry?
Secondary Job in the Industry
; Secondary Job: 1st Credit
Secondary Job: Title of 1st Credit
; Secondary Job: 1st Credit year
Year of Production
; Secondary Job: 1st Credit distributor
Distributor
; Secondary Job: 1st Credit type
Type of Production
; Secondary Job: 2nd Credit
Secondary Job: Title of 2nd Credit
; Secondary Job: 2nd Credit year
Year of Production
; Secondary Job: 2nd Credit distributor
Distributor
; Secondary Job: 2nd Credit type
Type of Production
; Secondary Job: 3rd Credit
Secondary Job: Title of 3rd Credti
; Secondary Job: 3rd Credit year
Year of Production
; Secondary Job: 3rd Credit distributor
Distributor
; Secondary Job: 3rd Credit type
Type of Production
; What is your tertiary (3rd) job in the Industry?
Tertiary (3rd) Job in the Industry
; Third Job: 1st Credit
Tertiary Job: Title of 1st Credit
; Third Job: 1st Credit
Year this one was produced?
; Third Job: 1st Credit
This one distributed by?
; Third Job: 1st Credit
Project type?
; Third Job: 2nd Credit
Tertiary Job: Title of 2nd Credit
; Third Job: 2nd Credit
Produced in (year)?
; Third Job: 2nd Credit
Distributor?
; Third Job: 2nd Credit
Kind of project?
; Third Job: 3rd Credit
Tertiary Job: Title of 3rd Credit
; Third Job: 3rd Credit
Produced when?
; Third Job: 3rd Credit
Who distributed this?
; Third Job: 3rd Credit
TV? Short? Feature? Documentary?
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PGA
; Check to indicate membership
DGA
; Check to indicate membership
WGA
; Check to indicate membership
ASC
; Check to indicate membership
SAG
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IDA
; Check to indicate membership
AIVF
RequiredAre you a Member of NALIP?
; Contact membership@nalip.org if you do not have this number
NALIP Member ID (on your ID Card)
Other Memberships
; If you have representation, list it here.
Your Agent
Agency Name
; What is the agent's phone?
Agent: Phone
; What is the agent's email?
Agent: Email
; Do you have representation by a manager and if so, by whom?
Manager
; What is your manager's phone number?
Manager: Phone
; What is your manager's email?
Manager: Email
; If you have Legal Representation, list it here.
Your Attorney
; Attorney: Phone
Your attorney's phone number
; Attorney: Email
Your attorney's email
Specialization
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