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Personal Information
I am a...(please check all that apply):

* First Name:
Middle Name:
* Last Name:
Pen Name:
* Address(Street):
Address 2:
* City:
Zip Code:
Home Phone:
Cell Phone:
* Email Address:
Date of Birth: Month: Day: Year:
Rep/Agency Name:
Rep/Agency Phone:
Rep/Agency Address:
Select Membership Level
Residents of Canada please note we will automatically add $10 to membership fee. Residents outside the U.S. and Canada. We will add $20 to the membership fee.
Supporting materials
Please use the instructions below to include any supporting materials with your application.

1. a copy of a review or a program from a production of my work before a paying audience.
2. a copy of a published script by a legitimate widely recognized publisher.

1. a copy of a script
2. a program from a reading or workshop of my work.

1. a letter from my professor or advisor on University letterhead.

You can upload files with the following extensions. pdf, doc, docx, xls, xlsx, jpg, jpeg, png, tif, tiff, gif
Make sure your file is under 7.5 MB.
Select a method of payment
* Card Number:
* Expiration Date: Month: Year:
* First Name on Credit Card:
* Last Name on Credit Card:
Required *