Society Membership Application

Society Membership Application

'Enter' will submit this form
Are you applying as an Independent Representative, or a Representative of your Organization?*

Independent RepresentativeOrganization Representative
Independent Information
Independent's Name*
First & Last
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Independent's Website (if applicable)
Brief description of your career history and connection to Actsafe *
Organization Information
Organization Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization's Website
Brief description of your organization *
Designated Representative
An Organization admitted as a Member to Actsafe must appoint a Person to be its designated representative and exercise the rights of membership on behalf of the Organization.

Membership Rights:
1. to receive notice of, and to attend, all General Meetings;
2. to make or second motions at a General Meeting and to speak in debate on motions under consideration inaccordance with such rules of order as may be adopted;
3. to exercise a vote on matters for determination at General Meetings; and
4. to participate in the programs and initiatives of the Society, in accordance with such criteria as may be determined by the Board from time to time.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Alternate Designated Representative
An Organization may also appoint an alternate designated representative who may, in the event the designated representative is not available to attend a General Meeting, exercise the rights of membership on behalf of the Organization.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Affiliations
Industry*

Performing ArtsMotion PictureBothOther
Please indicate which industry you are affiliated with:
Unions/Associations (if any)
Additional Information
How did you hear about Actsafe?
Would you be interested in volunteering on one of our standing committees?*

YesNo
Would you be interested in other volunteer opportunities? (i.e., AESC, AIP Week, etc.)*

YesNo
Additional Comments
If you would like to sign up to receive Actsafe's monthly newsletter to stay up-to-date on motion picture and performing arts industries’ health & safety news and information, please click here.
Signature

Clear
Applications for membership to the society are reviewed and approved by Actsafe's Board of Directors.

Once your application has been processed, you will receive a confirmation email from Actsafe. If you have any questions, please contact Actsafe at 6047334682 or info@actsafe.ca.
Should be Empty:

Society Membership Application

Independent Information

Organization Information

Designated Representative

Alternate Designated Representative

Affiliations

Additional Information