ACT-CO Membershp Form

ACT-CO MEMBERSHIP FORM 2011/2012

Complete the form and click Submit Form button below.
Mail your cheque to the address shown at the bottom of the form.


1. PUBLIC INFORMATION
The information in this section may be listed on the ACT-CO website and may be given out to the public seeking information on ACT-CO group members and is generally available to the public anyway.
Name of Group or Individual:
Group or Individual Mailing Address:
Group Phone Number:
Clubhouse/Rehearsal Address: (If any)
Clubhouse Phone Number:
Performance Venue Name & Address: (List all usual venues)
Box Office/Tickets Phone Number:
Website:
Public Email:

Month of Annual General Meeting:


2. FEES
Select one:	$75 - New Group*	* Groups joining ACT-CO for the first time must also send the following documentation: - A list of your volunteer Board of Directors/Executive with date of election. - A current membership list - A copy of your constitution - A copy of your letters patent verifying your not-for-profit, community theatre, status
	$60 - Group Early Renewal (before July 31st)
	$75 - Group Regular Renewal (after July 31st)
	$40 Group Half-Year (after January 1st)
	$15 - Individual


3. CONTACT INFO	Groups, list up to three individuals through which all ACT-CO business with the group will be directed.
This information is for the internal use of ACT-CO and WILL NOT be published, listed on the public pages of our website, shared with third parties, or given out to the public.
Group Contact #1 or Individual Member:
Name:
Position:
Email:
Home Phone:
Other Phone (e.g. Cell):

Group Contact #2:
Name:
Position:
Email:
Home Phone:
Other Phone (e.g. Cell):

Group Contact #3:
Name:
Position:
Email:
Home Phone:
Other Phone (e.g. Cell):

4. VERIFICATION
I, as an officer of the Group, verify that this organization if a not-for-profit community theatre group and I authorize the information in Section 1 to be released to the public.
Form Submitted by (Full Name & Position:
Email:
Re-enter Above Email Address:
Phone:

5. SUBMIT MEMBERSHIP FORM
You can submit this Form electronically or by mail. In either case, the cheque and any supporting documents must be mailed.
To Submit this form electronically:
To Submit this form by mail, print the form (use Print button at top of page) and mail to address below.
Make cheque payable to "ACT-CO" and mail to:
ACT-CO Membership Coordinator c/o John Wyman 27 Hartland Road Stoney Creek ON L8E 6C4