Membership Application

Membership Application
Organization Information
Organization Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Organization Website
Brief description of your organization
Designated Representative
Name

First Name Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Alternate Designated Representative
Name

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

Performing Arts Motion Picture Both Other
Unions/Associations (if any)
Additional Information
How did you hear about Actsafe?
Would you be interested in volunteering on one of our standing committees and/or other volunteer opportunities?

Yes No
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
Application Date

Month Day Year
Date
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.
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Organization Information