APPLICATION FOR MEMBERSHIP

Are you applying for:

Full Membership
Associate Membership

Name

Home Address

Phone

Email

Web site

Name & Address of Agent

In the event that you use more than one agent please give the details of the agent that represents you in Ireland.

Are you normally resident in ireland?

Yes
No

Which address should be used for the following:

Correspondence with the Guild   Publication on the web site, and in response to enquires  
Home   Home  
Agent   Agent  
Both   Both  
None   None  

Qualifications (degrees / diplomas / certificates)

Courses / Workshops Attended

Awards Received

Commissions / Contracts (name the project, and who contracted you):

Production Credits for Stage or Screen (writing only)

The Irish Playwrights and Screenwriters Guild
Art House, Curved Street, Temple Bar, Dublin 2, Ireland
Phone: +353-1-6709970