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PAYMENT FORM – EMMY® AWARD ENTRIES
Membership fees should be paid separately, and should not be included in your calculations of total entry fees owed
Check Amount Payable to NATAS Nashville
Purchase Order Amount to NATAS Nashville, 161 Rains Avenue, Nashville, TN 37203
Charge Amount to American Express
Charge Amount to MasterCard or Visa.
Visa/MC Credit Card Number: - - -
Amex Credit Card Number:       - -
Security Code:  

(4 digits on front of American Express, or 3 digits on back of MasterCard or Visa)
      
Name of Cardholder:
Expiration Date:
Billing Address:
City, State, Zip:

The Academy falls under IRS Code 501 (c)(6), and the Chapter Federal ID is 94-293-8871
 
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