VISUAL EFFECTS SOCIETY …

                      VISUAL EFFECTS SOCIETY
                         BUSINESS MEMBERSHIP PROGRAM
                          Connect  Be informed  Get seen


                        Power Circle Membership Form

Please check membership level:

           ___ Visionary      $50,000                                 ___ Innovator     $5,000
           ___ Leader         $25,000                                 ___ Friend        $1,000
           ___ Futurist       $15,000

Business Name ______________________________________________________________________

Name to appear on listing (if different than above) ____________________________________________

Authorizing Contact Name _____________________________ ________________________________

Address ______________________________________________City ______________________________

State ____________ Zip or Region Code ___________________Country ___________________________

Phone _______________________ Fax ________________________ Cell __________________________

Website _____________________ Email (limit 2) ___________________________________________

Enclosed is our check #__________ payable to Visual Effects Society in the amount of $ ___________.

We authorize Visual Effects Society to charge our credit card $ __________________.

VISA / MC/AMEX (circle) # ___________________________ Exp. ____/___ Billing Zip Code____________

CVC/CVV Code (3 digit VISA/MC; 4 digit AMEX)_________________(More about CVC/CVV Codes)

Name(s) as it appears on card ___________________________ Signature _________________________

Date of Signature __________________

Special Contacts (please specify contact information for events, advertising, job board and more)


Areas of Interest: (check all that apply) _____VES Awards Dinner___ Events ___Educational Programs____
Other Areas of Interest please list below: _____________________________________________________

Please send the completed form along with your business biography, credit/awards list and/or names of principals. This
information will be part of the VES database and may be searched by VES businesses and individual members. VES is a 501c3, not-
for-profit organization and your membership is tax-deductible to the fullest extent of the law. Federal Tax ID 95-4610023.


                                                For more information, contact
                                                 Aria Edry, VP Development
                                               818-981-7861 Fax: 818-981-0179
                                                aria@visualeffectssociety.com
                                                 www.visualeffectssociety.com
                                                  5535 Balboa Blvd., Ste 205
                                                      Encino,CA 91316


                                                                                                      Current as of August 6, 2008