Actor Registration- Time Bank Promo

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This form is for interested actors with disabilities to register for an opportunity to appear in a promotional video for the Good Neighbors Time Bank- highliting the benefits of time banking. The Good Neighbors Time Bank is supported by a generous grant from the Pennsylvania Developmental Disabilities Council

Email *

Actor’s Name *

Actor’s cell phone number *

Actor’s email address *

Additional contact person’s name

Additional contact cell phone

Additional contact email address

Age of Actor *

Actor’s gender

Female

Male

Prefer not to say

Non-Binary

Gender neutral

Clear selection

Does the actor have any film or stage experience? *

Yes

Is the Actor willing to sign an Image Use Release the day of filming *

Yes

Does the Actor agree to the $150.00 stipend to be paid via gift card? *

Yes

Is the Actor available for filming on August 16th in the Pottstown, PA area? *

Yes

Submit

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