Mail to:
Manon Rodriguez
PO Box 2900
Pahrump, NV 89041

APPLICANT'S BACKGROUND (Please print carefully)

Full Name: __________________________________________________________________

Address: __________________________________________________________________

City, State, Zip/Postal Code: __________________________________________________

Country: __________________________________________________________________

Phone (Home): __________________________________________________________________

Phone (Work): __________________________________________________________________

Email Address: __________________________________________________________________

Date of birth (Month/Day/Year): __________________________________________________

Professional Name: _____________________________________________________________

Business or Profession: __________________________________________________________

Company: __________________________________________________________________

College(s) Attended:
Degree(s): __________________________________________________________________

Are you interested in holding office or serving on local or national committees? (Publicity, Occult, Convention, Ethics, Membership, etc.)

If possible, would you affiliate with the nearest S.A.M. Assembly?

If no Assembly is available to you, would you, when conditions permit, be interested in helping organize one in your area?

MAGIC STATUS (check all that apply - see Instructions)

[ ] Professional
[ ] Magic Manufacturer
[ ] Part-time Professional
[ ] Dealer
[ ] Amateur
[ ] Collector
[ ] Assistant
[ ] Writer
[ ] Other (please explain):

TYPE OF MEMBERSHIP DESIRED (check one only, plus Sustaining Member if desired - see instructions)

[ ] Assembly(#)
[ ] Junior Assembly(#)
[ ] Associate
[ ] Contingency
[ ] Sustaining Member (indicate amount of contribution) $:

Have you previously been a member of this Society? [ ] Yes[ ] No
Please give old membership number (if known):

Have you ever been expelled from or refused membership in any magic organization?
[ ] Yes [ ] No
If so, give details

Give the name(s) of any magic organization(s) to which you belong:

Do you, or did you, hold any office in any other magical organization(s)?

[ ] Yes [ ] No If so, state the organization(s), office(s), and year(s) you held such office(s):

APPLICANT'S COMMENTS

Please use this space to give a short biography of yourself that will indicate how and when you became interested in magic; the type of magic that interests you most; your connection with shows, stage or club work; the extent of your magic collection; or anything which you feel will be of interest to magicians in general, and to the Society of American Magicians in particular. List any special skills you have (such as computer, artistic, stenographic, theatrical, typographic, technical, managerial, linguistic, musical, electronics, communications, etc.) List any hobbies besides magic:

Please read the Oath carefully, then sign and date.

OATH:

If accepted, I agree to elevate the art of magic, abide by the constitution, by-laws, code of ethics and rituals of The Society of American Magicians. I will cooperate with the Society in the promotion of its objectives, promote harmony and advance the ethics of the profession.

I will not condone the dissemination of trade secrets and principles related to magicians or magic effects with no effort or expectation by the recipient to obtain or acquire the information. I will not expose the secrets and principles of magic, nor will I support those who do. I will not copy, imitate, manufacture or sell the materials, ideas, principles, trade secrets or presentations of others without consent.

I will treat all my fellow compeers and all magicians with respect, encouraging fellowship, unity and cooperation.

Signed on Honor:

Date:

FOR ASSEMBLY APPLICATIONS ONLY-MEMBERSHIP SPONSORS

This applicant is vouched for as worthy of Membership by the following S.A.M. Members in Good Standing:

Name S.A.M.#
Address
City, State Zip
(signed)

Name S.A.M.#
Address
City, State Zip
(signed)

ADMISSIONS COMMITTEE The Committee on Admissions has investigated and finds The above applicant worthy of membership.
1. Date
2. Date

FOR NATIONAL OFFICE USE ONLY

Date Received
Date Filed
Membership #