Membership Registration

Page 1

Thank you for your interest in joining the Wildscreen Network! We need a few details from you to set up your membership. This should take less than 5 minutes.

Which membership type are you interested in registering for?

Page 2

Help us determine what membership level is right for you by answering the following questions.

How many film credits do you have?

0

1

2

3+

How many paid roles have you had?

0

1

2

3+

Membership Type

Price

Number of paid roles

Number of film credits

Page 3

Your Contact Information

First Name

Last Name

Phone

Email

Street Address Line 1

City

Post Code

State

Country

Page 4

About Your Company

Company Name

What are you hoping to achieve?

What type of company are you?

About You

Job Role/Craft Area

If you selected Other, please specify your title here.

Do you work freelance?

Yes

No

Date of Birth

Gender

Ethnicity

Ethnicity Sub-Type

Social Media

Where can we find examples of your work?

Facebook Profile URL Instagram Profile URL	Twitter Profile URL LinkedIn Profile URL
Website

Marketing Preferences

I have read and agree to Wildscreen Network's Data Protection Policy.

Yes

No

I would like to opt in to receiving news and updates from Wildscreen.

Yes

No

I am happy to be contacted by email.

Yes

No

I am happy to be contacted by phone.

Yes

No

Where did you hear about us?

Page 5

Payment

A payment is required to complete your membership registration.

Membership Type

Price

£

Payment Information

Name on Card

Card Number

MM

YY

Code

Billing Email