The Cape Independent Film Association   -ORGANIZATION MEMBERSHIP FORM- copyright ©2007 CIFA By filling out the following I agree to allow the CIFA to post my name and information on the CIFA membership roster so that I may be contacted to participate in local independent film/video projects. name                                                         date                               (please print and fill out all sections) Name    _________________________________ Address __________________________                             __________________________     Phone   _____________ Web & E-Mail    ____________________________________ Age     _____________ DOB   ____________ Sex     _________      Race   ____________ Body Type    ___________________ Hair    ________________    Eyes    _______________ Do you have any experience in theater, video production, or film production?     _ Yes  _ No If so which one(s)? ____________________________________ What are you interested in doing? (check as many as required) _ Directing  _ Producing  _ Writing  _ Cameraman _ Cinematography  _ Sound   _ Music    _ Make-Up Artist _ Acting    _ Production Assistant   _ Special Effects _ Costumes    _ Set Design/Props  _ Other __________________ _ Film Festival What equipment do you have available to use? (please check) _ Camera  _______________(type)   _ Sound _________________ _ Editing Software __________________   _ Special Effects equip. _ Lighting   _ Make-Up  _ Other  ______________________ Do you have (or belong to) a production company?   _ Yes     _ No Name of Company ___________________________ Address ________________________   ________________________ Phone ____________________    Web & E-Mail ________________ Please list the productions and duties you’ve been involved with. (please include year of production) _________________________  _________________________ _________________________  _________________________ _________________________  _________________________ _________________________  _________________________ _________________________  _________________________ Have you won any film, video, or writing awards?   _ Yes   _ No Which ones?   _______________________________________ Do you have any completed scripts or ideas for films?   _ Yes   _ No In what genres?   _____________________________________ What do you anticipate will be your level of involvement? (check one) _ Very Active _ Active _ Somewhat Active _ Not Much Active How were you referred to the CIFA? __________________________ Please briefly tell us about yourself, what you hope to get out of joining the CIFA, and why you decided to join..... __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ - PLEASE ATTACH ANY PHOTOS YOU WISH US TO USE - I affirm that the above is correct and authorize the CIFA to use the information for their own purposes. By signing I will now be considered a CIFA member. Name                                                               Date                             For more information visit the CIFA website www.capeindiefilm.com or e-mail us at admin@capeindiefilm.com Please deliver to: CIFA c/o  Michael Huntington 510 Broadway #A Cape Girardeau, MO. 63701 (573-334-5273)