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Name * First Last
Company / Organisation
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Phone Number
Mobile Number
Membership type: *
Professional $60 - (Please attach your CV including category, title, production company, format, date and duration of films worked on) Emerging Professional - $40 (Please attach your CV including category, title, production company, format, date and duration of films worked on) Student/Concession - $30 (Please attach on a separate sheet a CV as well as a Student ID or HealthCare Card) Associate - $40 (Associate membership is for those interested in being kept up to date with the growing screen industries in the Northern Rivers regio

Please confirm your membership status. Please note applicants for Professional membership must supply an updated CV with screen credits.

PAYMENT METHODS:
cash, cheque/money order, internet banking
Cheques to be made payable to
Northern Rivers Screenworks

Bank details: BSB: 802-222
Account number: 222 63812

Reference: Please put your Surname and Initial plus the word “FEE” in the reference line.
Sign off Name and date (please read acknowed

I, hereby apply to become a member of the above named incorporated association. In the event of my admission as a member, I agree to be bound by the rules of the association for the time being in force. I acknowledge this application will be read and signed by 2 Screenworks Board members as part of the application for membership process.
Age Range *
15 - 24 25 - 44 46 - 54 55 - 64 65+
Please state your MAIN area of experience or interest. *

EG: Camera, Director, producer, writer etc

A reminder, applicants for Professional membership must supply an updated CV with screen credits, email info@screenworks.com.au

PAYMENT METHODS:
cash, cheque/money order, internet banking
Cheques to be made payable to
Northern Rivers Screenworks

Bank details: BSB: 802-222
Account number: 222 63812

Reference: Please put your Surname and Initial plus the word “FEE” in the reference line.
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