AMERICAN GUILD OF VARIETY ARTISTS

MEMBER CHANGE OF ADDRESS
CHANGE OF EMAIL ADDRESS


TODAY’S DATE _______________________

LEGAL NAME _____________________________________________

STAGE NAME _____________________________________________

SOCIAL SECURITY NUMBER __________________________________

AGVA MEMBERSHIP NUMBER _________________________________

CURRENT EMAIL ADDRESS __________________________________

OLD ADDRESS ____________________________________________
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NEW ADDRESS ___________________________________________
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Please mail this completed form to:

American Guild of Variety Artists
363 Seventh Avenue – 17th floor
New York, New York 10001
ATT: Membership Department