NorthEast Country Music Association

Membership Application

Printing Instructions:
1. With your mouse, select page 1 of the form.
2.From the File Menu Click Print
3. In the Print Dialogue Box click Selection, then OK
4. Insert the form printed side up into your printer.
5. Select page two of the form and repeat steps 2 and 3


NorthEast Country Music Association
Membership Application Please Print Clearly or Type Information:	______________
	Date

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Name	Phone #

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Address

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City State	Zip Code

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E-Mail Address (Please Print Clearly)

Please check one: [ ] I am over 18 years of age [ ] I am under 18 years of age ___________Year born (if under 18) Type of Membership: [ ] New [ ] Renewal [ ] General: $10.00 available to any fan of Country Music [ ] Professional: $15.00 available to anyone who is now or has actively performed or promoted Country Entertainment. Please fill in the back of this form. Please make checks payable to: Northeast CMA (do not send cash) Mail to: Northeast Country Music Association Inc, PO Box 511, Clifton Park, NY 12065

-Note-

Please Fill In Page 2 Of This Form


Page 2

Please Fill In Information (Professional Applicants Only)

Professional Status: Musician Entertainer Radio Studio DJ Singer/Songwriter Dance Instructor Nightclub Music Store Other______________________________________

Your Specialty Bass Drums Vocalist Lead Guitar Steel Keyboards Banjo Fiddle Rhythm Guitar Mandolin Other______________________________________

Please State Qualifications and/or Affiliations:

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Would you like to be listed in our Musicians Directory? Yes No

Please check one: NO ONE REFERRED ME I WAS REFERRED BY: __________________________________________________

SIGNATURE:_________________________________________________________________

Thank You