American Federation of Television & Radio Artists

Please return this form to Michele Caruso, Committee Coordinator,
via email to mcaruso@aftra.com or via fax to 212-545-1238.

I am interested in becoming a Stanley Greene Media Training Center Instructor.

Name:______________________________   Date:________

Member I.D. No.:___________________   E-mail:___________________

Phone No.:___________________   Service:___________________

Please Check Appropriate Answers:

I am interested in:		_____ a. Teaching _____ b. Operating equipment (for private sessions only) _____ c. Editing _____ d. Other______________________
Availability:		_____ a. Weekly Classes _____ b. Substitute Instructor _____ c. Other______________________

YOUR BACKGROUND

Have you taught a class before?_________

Where?______________________________

What type of class?___________________________

For how long?________________

I am most interested in being an instructor because:

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

__________________________________________________________

Thank you for taking out the time to fill out this application. Your application will be held on file. You will be called in turn as classes are formed, or you may be called on an as needed basis.