NYCPlaywrights Actor Membership Form

Date:__________________________________________________

Name: _________________________________________________

Stage Name: __________________________________________________

(if you prefer to use it rather than your real name)

Contact Information:

Phone: _____________________________________________________

Email: ______________________________________________________

Are you a member of Actors' Equity?
YES / NO

(circle one)

Are you a member of any other actors union? If so, which ones?

Actor members must attend at least one meeting every three months in order to remain a member.

Membership may be discontinued at the discretion of NYCPlaywrights.

NYCPlaywrights is a 501(c)(3) nonprofit corporation.

I understand and agree to these terms

Your signature: ____________________________________________________________