Upon final qualification for AWC membership, I authorize the Writers
Guild of America, west, Inc. to charge my
(check one) ___ MASTER CARD or ___ VISA for payment of my:
(check one) ___ $75.00 one year service fee for Animation Writers Caucus
membership.
____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____
(account number)
Expiration date: _____ / _____ / _____
______________________________________________________________________
Signature (as it appears on credit card)
______________________________________________________________________
Please print name (as it appears on credit card)
______________________________________________________________________
Please print professional name used for Guild records and correspondence
(if different from above).
