Membership Application

Please read the Rules and Regulations for membership first. We would like you to understand the special relationship we have with theatres. Membership cost is divided into: $85 annual membership and $30 to set up your Personal Reserve Fund for an initial total cost of just $115 to join. Please print a hard copy of this page, fill in the required information and be sure to sign it. You may mail or fax the completed application to AE. We will process it as soon as it is received.

Method of payment: ____ Amex _____ Visa ____ MasterCard ____ Check for $115

Card No. _______________________________ Exp. Date: _____________ Name: ________________________________________________________ Address: ______________________________________________________ City: ______________________ State: ___________ Zip: ______________ Day Phone: ___________________ Night Phone: ______________________ I wish to use following five digit numerical PIN #: ____ ____ ____ ____ ____

My signature acknowledges my understanding and willingness to comply with all AE rules, regulations and audience development goals. I pledge to be discreet and practice good audience etiquette at all events. I understand my membership is continuous until I give AE 30 days written cancellation notice and surrender all membership ID cards.

Signature: __________________________________ Date: ______________

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Mail this completed application to: Audience Extras 61 Lexington Avenue Suite 1-A New York, NY 10010

Or fax it to: 212-633-9262 Still have Questions? Call 212 686-1966