| Name |
first
________________________ last
_______________________ |
| Address |
street/PO
box ___________________________________________ |
|
city
_______________ state
___ zip
________ country
__________ |
| Contact |
home phone
__________ work
phone __________
fax __________ |
|
email
_____________________ website
_____________________ |
| I am a
(check all that apply) |
|
| ___
composer |
___
organization/institution |
| ___
performer |
___
subscribing to the newsletter only |
| ___
ensemble |
|
| Dues |
|
| ___ U.S. Address
$50 |
___ Non-U.S. Address
$60 |
| ___ U.S. Student
$35 |
___ Non-U.S. Student
$45 |
| ___ U.S. Senior
$35 |
___ Non-U.S. Senior
$45 |
| ___
First class postage on Sounding Board: additional $10 |
|
Please accept my contribution
of $________ in addition to my membership.
|
| If you're
giving this membership as a gift, please enter your name and address
here: |
| Name |
first
________________________ last
_______________________ |
| Address |
street/PO
box ___________________________________________ |
|
city
_______________ state
___ zip
________ country
__________ |
|
Print out this form
and send it along with a check or money order to:
AMERICAN COMPOSERS
FORUM
332 Minnesota Street, Suite E-145
Saint Paul, MN 55101-1300