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Title Mr Ms Mrs Miss Name* Business Name Address* Home Phone* Work Phone* Fax Mobile* E-mail* Age (Confidential – For data collection purposes only) Please select... <18 18-25 26-33 34-41 42-49 50+ Membership Category Full member (Income $70K+)   (NSW/Vic)           Full member (Income $70K+)   (Other states/Overseas)    Full member (Income $50K+)  (NSW/Vic)               Full member (Income $50K+) (Other states/Overseas)       Full member (Income $40-50K)    (NSW/Vic)            Full member (Income $40-50K)   (Other states/Overseas)   Full member (Income $25-40K)      (NSW/Vic)                 Full member (Income $25-40K)  (Other states/Overseas)    Full member (Income under $25K)       (NSW/Vic)                  Full member (Income under $25K)      (Other states/Overseas)      Associate (Individual)                      Associate (Institution)                     Associate Student member                Corporate Bronze  Corporate Silver  Corporate Gold  

All rates are inclusive of GST
No Income means: No Income from film-related pursuits over the previous 12 months Must provide proof of enrolment in full-time study (please fax photocopy of student card to 02 95557086)

Professional Category Director Independent Producer Writer In which genre/area do you work: Animation Arts Children’s Comedy Commercials Corporate / Non-broadcast Documentary  Education / Training Feature Films Entertainment  Live / OB Magazine Multi-camera studio Multimedia/New Media (including phone, Internet, games etc) Music Nature/Wildlife News/Current Affairs TV Series / Serials  TV Movies TV Mini Series Science Shorts Sports Payment Method Please select... Visa PayPal Mastercard

Credits

Full members must attach a CV listing their credits, production titles and lengths. Please include the name of at least one referee, preferably an ADG member or a recognised filmmaker.

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