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(please
print and mail to address below)
NOSOTROS MEMBERSHIP
APPLICATION & RENEWAL
General Info: (323) 465-4167 President's
Office: (323) 466-8566 Website: www.Nosotros.org
Referred
by:_______________________________________________________________________________
Date____________/___________/___________
(check one) New
Member:_______________ $50 Renewal:_____________ $40 (within 30 days from expiration date)
Legal Name:
Last_______________________________________________________________________First:______________________________________________________
Stage Name:
_____________________________________________________________________________________________________________________________________
Mailing
Address:_______________________________________________________________City:_______________________________State:____________Zip:_____________
Home Phone:
(
)______________---_________________ Other #: (
)______________---___________________ Other #:
(
)__________---___________
Email:
_____________________________________________________@_____________________________________________
DOB (year optional) ________/______/______
Industry Occupation (please submit
resume):_____________________________________________________________________________________________________________
Industry Technical skills (i.e.: lighting,
sound, costumes, set design,
etc)_________________________________________________________________________________________
Non-Industry Occupation/Technical Skills
(please submit
resume):_____________________________________________________________________________________________
Affiliation(s):
(circle all applicable ) SAG AFTRA EQUITY SEG ASCAP DGA WGA
OTHER:_______________________________________________________________________
If
you are an actor what age range do you
play? under
16_______
16-18_______
18-25_______
25-35_______
35-45_______
45-55_______
55+_______
Why do you want to be a
member?____________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________
Representation:
Theatrical
Agency:_________________________________________________________
Contact:_______________________________
(
)__________---______________
Commercial
Agency:_______________________________________________________
Contact:________________________________
(
)__________---______________
Management:_____________________________________________________________
Contact:________________________________
(
)__________---______________
Other:__________________________________________________________________
Contact:_________________________________
(
)__________---______________
Signature:_________________________________________________________________
Date:____________________________________
Please
attach check made payable to NOSOTROS, and (4) Headshots
and/or Resumes
Mail
To: Nosotros Membership 1615 N Vine Ave Hollywood CA
90028
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