PRINT THIS PAGE, FILL OUT AND MAIL IT TO OUR OFFICE OR SUBMIT THE INFORMATION BY E-MAIL

APPLICATION FORM

PLEASE READ FIRST!

This form is for: producer companies, producer houses, casting agencies, radio or TV companies, movie producers, directors and managers, theatrical troupes, dancing formations, galeries, chorus, orchestras.

YOUR FIELD:______________________________________________________________________

COMPANY NAME:___________________________________________________________________________________________

ADDRESS:(Street No.)__________________________________________________________________Unit No.______________

CITY:____________________________________________PROVINCE/COUNTRY:____________________ZIP CODE:__________

PHONE:_______________________________________Ext.________________FAX:_____________________________________

E-MAIL:__________________________________________________WEB SITE:_________________________________________

_________________________________________________________________________________________________________

MORE INFORMATION:________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

WHAT SERVICE WOULD YOU LIKE TO USE?______________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________

LANGUAGES FOR CONTACT:__________________________________________________________________________________

WE_______________________________________________WOULD LIKE TO BECOME A MEMBER OF INTERNATIONAL TALENT CLUB.

FOR COMPANY:(Please print the representative name.)______________________________________________________________

SIGNATURE:____________________________________________________DATE:______________________________________

_________________________________________________________________________________________________________

***DO NOT WRITE IN THIS FIELD! OFFICE USE ONLY.

DATE START__________________DATE END______________________FEE PAID(In US $ only)___________________________

AGENT NAME:___________________________________________SIGNATURE:________________________________________

CANADA____________USA____________EUROPE__________AUSTRALIA__________OTHER____________________________