Membership Application

Download the application – DOC, PDF – or fill out and submit the electronic form below:

To become a member simply mail a copy of the form, (along with any other information we require for your particular category), along with your payment to:
AMPIA
#318, 8944 – 182 St. NW,
Edmonton, AB T5T-2E3
Ph: 780-944-0707

Fax your forms to: 780-426-3057
Scan/E-mail to: pgerlach@ampia.org (Paula – Re: AMPIA Membership )

Please make Cheques Payable to: AMPIA or: Alberta Media Production Industries Association

AMPIA Membership Application

Last Name

First Name

Company (if applicable)

Telephone

Fax

Email (required)

Website (if applicable)

Address

City

Province

Postal Code

Please provide a brief description (250 characters maximum) of your business below:

Category (GST included)
Please review the various categories and mark appropriate category for this application.
Call the AMPIA office if you have any questions regarding category designation. 780-944-0707

AMPIA will contact you re: payment

• A Categories (PRODUCER) - Requirements as outlined in the category information must be included with application.
• Category B5 - Resume must be included with application.
• Category C1 - Please provide list of student names & e-mails (registered in full time program).
• Category C2 - Proof of enrollment must be included with application.

Payment Options
Cheque Credit Card
If paying by credit card, call 780-944-0707.
Mail cheques to:
AMPIA
#318, 8944 – 182 St. NW,
Edmonton, AB T5T-2E3

Please make Cheques Payable to: AMPIA or: Alberta Media Production Industries Association

For all New/applying members please provide the name of any AMPIA member in good standing

Comments

Unless otherwise instructed the information contained on this application will be posted on the personal and company profiles on the AMPIA Website.