MEMBERSHIP PROFILE AND APPLICATION
PLEASE USE THE PRINT BUTTON ON YOUR BROWSER
TO PRINT THIS FORM, THEN FILL IN
THIS FORM AS COMPLETELY AS POSSIBLE AND MAIL IT IN TO THE ADDRESS BELOW:
MEMBERSHIP: [ ] NEW [ ] RENEWAL
_____________________________________
_________________________________________
Name
Title/Department
_____________________________________
_________________________________________
Address
Company/Organization
_____________________________________
_________________________________________
City
State
Zip
Email Address: _____________________________________________________________________
Phone:
Work (_____) ________ - __________________ x_______
FAX# (_____) ________ - __________________ x_______
Home (_____) ________ - __________________ x_______
(__) Please send me information about national membership in USITT
USITT/Ohio Valley Section Dues (Make
checks payable to: USITT/Ohio Valley Section):
[ ] $75.00 per year Sustaining Membership (W)
[ ] $40.00 per year Organizational Membership (X)
[ ] $25.00 per year Individual Membership (Y)
[ ] $10.00 per year Student Membership (Z)
Please identify three areas in which you
are most interested in order of preference by using #1, #2, #3
[ ] Architecture (R) [ ] Costume Design & Technology (T) [ ] Education (U)
[ ] Engineering (V) [ ] General (Q) [ ] Health & Safety (W)
[ ] Lighting (X) [ ] Scenic Design (Z) [ ] Sound Design (P)
[ ] Television
(O) [ ]
Theatre & Production Management (Y)
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Mail membership form and check to:
USITT - Ohio Valley
c/o Vincent Lighting
6161 Cochran Rd Ste D
Solon, OH 44139