EmailMe Form - Member Application

Referral Source *

Email *

Most frequently checked inbox.

Government Name *

First Last

Performer Alias *

First Last

Preferably a realistic stage name.

Phone Number *

### - ### - ####

Must be text enabled.

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Gender *

Male

Female

Profile Picture *

Showcase your best selfie.

Driver's License *

Place on the countertop, front side up, showing all 4 corners of the card.

Back of the license. *

Place on the countertop, showing all 4 corners of the card's backside.

Verification *

Take a picture holding your license, text must be readable.

Acknowledgment *

Clear

I am paying a monthly membership fee to cover the service of enrolling into The 19th Society. The 19th Society agrees to provide administrative support across various platforms. I understand that to receive payment, I must first provide additional documents as part of the KYC (Know Your Customer) compliance process. I have received a comprehensive list of acceptable documents, along with a video explaining the KYC procedure. I acknowledge that after I complete this form, I will be sent to a payment gateway to pay for the membership. The attached drivers license with me holding the card will stand as proof that the transaction is authorized and legitimate.