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PROFESSIONAL NAME

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LEGAL NAME

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ADDRESS

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CITY/STATE/ZIP

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PHONE NUMBER

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UNION AFFILIATIONS AND LENGTH OF MEMBERSHIP

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SOCIAL SECURITY NUMBER

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SHOW OR FILM AND DATE (IF KNOWN)                         CHOREOGRAPHER

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SIGNATURE                                                                                     DATE

COME DANCE WITH US!
_ ELIGIBLE GYPSY

A dancer or choreographer with three years* of verifiable work including union and /or guild affiliatiations.

please include resume
  *This need not be three consecutive years to be eligible to receive PDS benefits.

_ GYPSY

Teacher, Students, and Supporters of Dance.

MEMBERSHIP DUES

$20      Initiation
$25      Annual dues
$45      First year total due
$10      Age 62 and over 
           annual dues

Please make checks payable to the
Professional Dancers Society

Professional Dancers Society
270 N. Canon Drive, PMB 2049
Beverly Hills, California 90210
Telephone (310) 278-5222
Fax (310) 278-1591

An affiliate of the Actor's Fund of America