BESS Contributorship Application/Renewal Form

This is a (circle one):     New Application    Renewal

For Renewals, please enter your contributor number (if you know it). For New Applications, a Contributor Number will be assigned.


 Contributor Number
 

First Name                                                                                                                           

Last Name                                                                                                                           

Scene Name                                                                                                                       

E-mail Address                                                                                                                   

May we contact you via email (circle one)?   Yes   No

Date                                                                                                                                     

**For demographic information only (optional)

State                                                                                                                                                             

Zip                                                                                                                                                                

How did you hear about BESS?                                                                                                                  

Special instructions to the Database Manager                                                                                               

                                                                                                                                                                        

I certify that I am at least twenty-one (21) years of age. I also certify that I have read and agree to abide by all BESS rules, including, but not limited to, the Safe Space Policy, Party Rules, and the Contributorship Agreement.

Signature                                                                                                                                              

BESS Representative checking Identification: