Please print
and fill out this form and then go to the next
oneMake sure to fill out the 4 pages
page 3 of 4
Please print
and fill out this form and then go to the next
onePlease print or type:
Applicant's Name: ________________________________________________________________
Phone Number: ( _______ ) ________________________________
Social Security Number: _________________________
Kindly complete the following:
(This information will remain on WGA computers until we receive written
notice to change such information.)
Are you presently being represented by an agent? Yes ___ No
___
If yes, Name of Agency: _______________________________________________________________________________
Individual Agent's Name: _______________________________________________________________________________
Is your agreement: Written ___ Oral ___
For a list of Agents, please contact the WGAw Agency Department at (213)
782-4502.
Many requests to contact members of the Guild are received by our Agency
Department. Because WGA policy precludes us from giving out the addresses
and telephone numbers of our members (unless we are given permission to
do so), it is assumed that you wish your calls to be referred to your agent.
If not, please indicate with the words DO NOT REFER next to your
agent's name above.
If you do not have an agent (or do not want your calls referred to your
agent):
Be sure to have calls referred to a business manager, personal manager,
attorney, or some other individual (please specify) in the event that industry
personnel are trying to contact you about a writing assignment.
Name & Title: _______________________________________________________________________________
Address: _______________________________________________________________________________
Phone Number: ( ________ ) ______________________________________________________
