Screensearch - Welcome

Extras

Please complete this form and send it to us either by email or by post. Please bear in mind that email is not a secure payment method and any information provided is at your own risk. Until we introduce our online sign up we recommend sending the form by post to: Screensearch Extras Agency, Suite N1, The Priory, Syresham Gardens, Haywards Heath, West Sussex RH16 3LB

First name		Surname
Title
Address


Post Code
Telephone (Day)
Evening
Mobile
Sex	Male Female
Date of birth
Basis of registration	Postal Monthly Registration - pay Ł12 on application and a further Ł12 per month and this covers the use of the OnLine Directory, filming fee and inclusion in the Book version distributed to all productions. There will be no commission nor additional registration fees deducted from earnings.
	Postal Year Registration - pay Ł100 on application and this covers the use of the OnLine Directory, filming fee and inclusion in the Book version distributed to all productions. There will be no commission nor additional registration fees deducted from earnings.
Payment details	I attach a cheque/postal order made payable to Screensearch for Ł100 (Annual option only)
	Please debit Ł100 lump sum or Ł12 per month from my credit card using the following details:
	Expiry Switch No

I apply to join the Screensearch Extras Directory and acknowledge that I have read and agree to the terms and conditions (Ref8.1101). I also agree that if I subsequently convert to an OnLine membership no refunds of fees will be made. Where I have indicated payment by credit/debit card, I also authorise the deduction of the initial fee (and subsequent fees for the Monthly option) from my credit/debit card as detailed above and understand that the minimum term for the Monthly option is 6 months after which either of us may terminate with 1 months written notice.


Signature


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