Renewal date ________________________

CFAA MEMBERSHIP APPLICATION (annual – 12 months)

Name_________________________________________________________________________

Email ________________________________________________________________________

Phone ________________________________________________________________________

Mailing _______________________________________________________________________

Website? ______________________________________________________________________

Film Affiliation / Title ___________________________________________________________

Special skills, equipment, resources ________________________________________________

Please check one:

Individual Membership ($25) ________________ Date _________________________Business

Membership ($100) ________________ Date _________________________

(includes admission for up to 4 company reps, link on website, display/distribution of info at CFAA events)

Signed _________________________________________________________________

Accepted by CFAA _______________________________________________________