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| MEMBERSHIP INFORMATION | Date
  Submitted: |   | ||||||||||||||||||
| Please submit completed form and payment to the WIFTA office. Only
  membership applications received with payment will be processed. | ||||||||||||||||||||
| Name: |   | |||||||||||||||||||
| Mailing Address:  |   | |||||||||||||||||||
| City: |   | Province:  |   | Postal Code: |   | |||||||||||||||
| Business Phone: |   | Home Phone: |   | Mobile: |   | |||||||||||||||
| Fax: |   | Email: |   | Web site: |   | |||||||||||||||
| Connection to Industry:
   |   | |||||||||||||||||||
| MEMBERSHIP CATEGORIES: (Please check one) Includes membership to
  WIFT-International | ||||||||||||||||||||
| Voting Member  | This provides you with full
  member privileges as well as full voting privileges at the Annual General
  Meeting. (Requires a Minimum of Two Years Professional Experience in the Film
  & Television Industry)������  | $ 35.00 | ||||||||||||||||||
| Non-Voting Member | This provides you with
  full membership without voting privileges at the Annual General Meeting.� (For those with less than two years
  Professional Experience in the Film & Television Industry OR Individuals
  interested in supporting WIFT-A but not in having voting privileges). |  | $ 40.00 | |||||||||||||||||
| Student | Students
  enrolled in full-time studies. (Valid Student ID Required) |  | $ 20.00 | |||||||||||||||||
| Membership
  payable by cheque, cash or money order made out to Women in Film and
  Television � Alberta. Credit Card payments can be made on-line at www.wifta.ca.  | ||||||||||||||||||||
| WIFTA MEMBERSHIPS EXPIRE ON MARCH 31 ANNUALLY. RENEWAL NOTICES WILL
  BE SENT OUT. | ||||||||||||||||||||
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| Volunteer
  Committees:    | ||||||||||||||||||||
| �Professional Development����������� �Communications������������� �Networking Nights/Special Events �Fundraising���������������������������������� �Lobbying������������������� �������Operations/Office   | ||||||||||||||||||||
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| Privacy and Use of
  Information (please read carefully)  WIFT Alberta keeps membership
  information in a computer database including details such as names,
  addresses, telephone numbers, email addresses, type of membership, conference
  registrations, product orders, email newsletter subscriptions, contact
  information/requests, events, links and job submissions. This information is
  used only for the operation of WIFT Alberta.   Disclosure of the above
  information is restricted to: 1. Directors of WIFT Alberta on
  request. 2. Committee members to enable
  them to undertake specific tasks on behalf of WIFT Alberta. 3. Others to enable the
  newsletter, or other pertinent information, to be mailed or emailed directly
  to the members. 4. A listing of name and contact
  information only in the Women in Film & Television � International
  Database   We do not give member or
  non-member email addresses to any third party sites, companies or
  organizations.   To meet the requirements of the
  Freedom of Information and Privacy Act we must have your permission to keep your
  personal details in a computer database and for using that information as
  indicated. When you sign this form you will be giving WIFT Alberta the
  necessary permission. The computer database is WIFT Alberta�s sole
  arrangement for registering your personal details.   Please check one of the boxes
  below:   �Yes, I
  give Women in Film and Television � Alberta permission to include my name and
  contact information in the WIFTA membership directory & Women in Film and
  Television � International Database.  �No, I do not give Women in Film and
  Television � Alberta permission to include my name and contact information in
  the WIFTA membership directory & Women in Film and Television �
  International Database.  If you have
  any questions or concerns please contact the office at [email protected]. | |||
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|   | Signature of Applicant |   | 
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