2015 MEMBERSHIP FORM

MEMBERSHIP TYPE AMOUNT DUE Mr. Ms. (select one) Name: PromaxBDA Executive $1,995.00 Title: PromaxBDA Professional $199.00* Organization:

Address: *Basic member price is subject to a one-time processing fee of $25.00 for all new or lapsed members renewing after January 31, 2015. City: State: Zip Code: Phone: Fax: Email: Website:

PLEASE CHECK THE APPROPRIATE BOXES IN THE 4 AREAS BELOW TO PROVIDE INFORMATION ABOUT YOU AND YOUR COMPANY

1 CHANNELS (NBC, MTV, FOX, Canal+, SERVICE VENDORS/ 2 DEPARTMENT/AREA 4 JOB DESCRIPTION BBC, A+E, etc) AGENCIES/CONSULTANTS OF BUSINESS Marketing Cable Channel (MTV, Discovery, Bravo, Design/Motion Graphics/Animation Marketing Promotion Disney Channel, etc.) Creative Services/Advertising Agency On-Air Promotion Design Broadcast/Terrestrial Network (NBC, ZDF, Production – Live Action Creative Services CBS, BBC, DR, etc.) Sales Post Production/VFX/Editing Services Programming Pay TV/Subscription Channel (HBO, Programming & Production Eurosport, LAPTV, Showtime, etc.) Internet/Interactive Services (creative, Design Public Relations technical, etc.) Satellite Channel (Audience Network, Distribution Affiliate Marketing Integrated Marketing ARTE, DW-TV, etc.) Legal Services Network Affiliate Marketing Technical Internet Channel (Pitchfork, Machinima, Media/Strategy Agency Research Crackle, etc.) Research Music & Sound: Licensing, Library, Interactive/On-Line CONTENT PRODUCERS, Composition Education/Training Media Planning PROGRAM DEVELOPERS, Research Company Strategy SYNDICATORS, DISTRIBUTION PR PR Agency Finance (Warner Bros. Television, Endemol, Sony Production Television, Shine, etc) Recruitment Agency Other: Post Production Studio /Program Production (Shine, Voiceover Endemol, Lionsgate, etc.) Creative Services Premiums/Incentives Provider Syndicator/Distributor (Warner Bros Legal Event Production/Special Events Television, Debmar Mercury, Sony Ad Sales Television, etc.) Technology Provider Business Development/Sales Home Entertainment (Walt Disney Talent Agency Studios, 20th Century Fox, BBC Home HR/Recruitment Independent Consultant/Freelance Entertainment, etc) Other/Independent MSOS/MVPDS (Comcast, Time OTHER 3 JOB LEVEL Warner, Star, DIRECTV, Virgin Media, etc.) Trade Association or Conference Executive Management (CMO, Cable (Comcast, Time Warner, Virgin Publications (trade, industry, consumer) Media, ONO, etc.) EVP, SVP, Managing Director, etc.) Satellite (DIRECTV, DISH, SKY, etc.) ACADEMIC Senior Management (VP, Executive Producer, etc.) Game/Entertainment Console (Xbox, Educator RENEW Director Playstation, etc) Student Internet (Hulu, iTunes, Youtube, etc.) Mid-Level (producer, manager, etc.) ONLINE! SPORTS TEAMS & LEAGUES Mobile (AT&T, Orange, Verizon, etc.) Entry Level (assistant, coordinator, etc.) Visit promaxbda.org and click on Teams the “membership” tab to get started. Leagues & Governing Bodies

METHOD OF PAYMENT Payment must accompany this invoice; please do not email/mail separately. Membership Fee $ Visa Mastercard American Express

Total Amount $ Check # Exp Date (MM/YY) Security Code Credit Card # Signature Conference Registration Amount $

Please mail completed form along with payment to: Fax (credit card payments only): +1 310.788.7616 NOTE: PromaxBDA memberships are individual memberships and are not transferable or refundable. Memberships can be purchased on a year-round basis, but are based on the PromaxBDA calendar year and will expire December 31. Any questions or concerns should be directed 1522e Cloverfield Blvd. For additional information, please call Member Services at to Member Services. PromaxBDA membership dues are not deductible as a charitable +1 310.789.1509 or email [email protected] contribution for Federal or National tax purposes. However, they may be tax deductible as Santa Monica, CA 90404 ordinary and necessary business expenses. Usually 100% of your dues are tax deductible, USA or visit our website at promaxbda.org. because PromaxBDA does not participate in any lobbying activities on behalf of its members. Always consult your advisor regarding these matters.