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Academic Membership Application

Complete the application form below. For student and academic personnel, please click here.

Your Information

Name(Required)

First Last

Email(Required)

Mobile Phone Number(Required)

Please include "+" country code, area code and phone number in this field.

Address(Required)

Street Address Address Line 2 City State ZIP Code

About You

Do you currently work in the entertainment industry or a non-profit in the industry?(Required)

Yes

No

Other

Job Title(Required)

Company(Required)

Describe the capacity of your role.(Required)

How long have you worked in the entertainment industry?(Required)

What is your craft or area of expertise?(Required)

What are your career goals?(Required)

How can Imagen help you achieve your career goals?(Required)

Would you be interested in participating as a juror for the Imagen Awards?(Required)

Yes

No

Other

How did you hear about Imagen Insiders?(Required)

Colleague

Friend or Family Member

Email

Social Media

Other

Who referred you?

If you were referred by a colleague, friend, or family member, please share their name with us.

Create Your Profile

Username(Required)

Password(Required)

Enter Password Confirm Password

Membership Level

Select the membership level that you would like to subscribe to. All membership subscriptions auto-renew until you cancel. You will receive email notifications before your membership auto-renews.

Would you like to subscribe to an annual or quarterly membership?(Required)

Annual

Quarterly

Annual Membership Plans(Required)

Select one.

Associates (Annual)

Executives & Creators (Annual)

Non-Profit (Annual)

Quarterly Membership Plans(Required)

Select one.

Associates (Quarterly)

Executives & Creators (Quarterly)

Non-Profit (Quarterly)

Checkout

Code

If you've been provided with a code, please enter it here.

Total

Payment Method(Required)

PayPal

Credit/Debit Card

Payment Method(Required)

American Express

MasterCard

Visa

Supported Credit Cards: American Express, MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Credit/Debit Card(Required)

Billing Address(Required)

Same as address entered previously

Street Address Address Line 2 City State ZIP Code

Your Information

Name(Required)

First Last

Email(Required)

Mobile Phone Number(Required)

Please include "+" country code, area code and phone number in this field.

Address(Required)

Street Address Address Line 2 City State ZIP Code

About You

Which best describes your role?

Professor or teacher

Researcher

Student

Job Title(Required)

Department(Required)

School Name(Required)

Year in School(Required)

1st Year

2nd Year

3rd Year

4th Year

Post-Graduate

Other

Field of Study(Required)

Do you have experience working in the entertainment industry?(Required)

Yes

No

Other

Describe the capacity of your experience.(Required)

What is your craft or area of expertise?(Required)

What are your career goals?(Required)

How can Imagen help you achieve your career goals?(Required)

Would you be interested in participating as a juror for the Imagen Awards?(Required)

Yes

No

Other

How did you hear about Imagen Insiders?(Required)

Colleague

Friend or Family Member

Email

Social Media

Other

Who referred you?

If you were referred by a colleague, friend, or family member, please share their name with us.

Create Your Profile

Username(Required)

Password(Required)

Enter Password Confirm Password

Membership Level

Select the membership level that you would like to subscribe to. All membership subscriptions auto-renew until you cancel. You will receive email notifications before your membership auto-renews.

Membership Plans(Required)

Select one.

Academic (Annual)

Academic (Quarterly)

Checkout

Code

If you've been provided with a code, please enter it here.

Total

Payment Method(Required)

American Express

MasterCard

Visa

Supported Credit Cards: American Express, MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Billing Address(Required)

Same as address entered previously

Street Address Address Line 2 City State ZIP Code

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