Membership Application

Fill out and submit the electronic form below or download the PDF form.

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
Suite 350, 5305 Allard Way
Edmonton, AB T6H 5X8
Ph: 780-944-0707

Fax your forms to: 780-426-3057
Scan/E-mail to: lmcneill@ampia.org (Lindsey – 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
Suite 350, 5305 Allard Way
Edmonton, AB T6H 5X8

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

Enter the text below into the field in order to submit the form

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

Alberta Media Production Industries Association