Maine Academy of Country Music
Membership Application

It is very important that you give us as much information as you can.


PLEASE PRINT


Todays Date:____________________


#1) Primary Member or Individual Membership Name:__________________________________________

Date of Birth for #1): Month_______ Day_______


For Family Membership with Partner + up to 3 additional (under 18 years of age)
living in same household. Please complete #2 through #5.
MAXIMUM FAMILY MEMBERSHIP = 5


#2) Full Name:_____________________________ Relationship_______________

Date of Birth for #2): Month_______ Day_______


#3) Full Name:_____________________________ Relationship_______________

Date of Birth for #3): Month_______ Day_______


#4) Full Name:_____________________________ Relationship_______________

Date of Birth for #4): Month_______ Day_______


#5) Full Name:_____________________________ Relationship_______________

Date of Birth for #5): Month_______ Day_______


Your Mailing Address:______________________________________

City:___________________ State:_______ ZIP:________________

Home Phone: (_______)_______-_____________

Cell Phone: (_______)_______-_____________

Fax Phone:  (_______)_______-_____________


EMail: ___________________________________


ALL DUES ARE PAYABLE PRIOR TO JANUARY 1ST OF EACH YEAR
YOU MAY PREPAY YOUR DUES AT ANYTIME DURING THE YEAR


Dues are:

INDIVIDUAL: $12.00
FAMILY (Up to 5): $24.00 (all must live in same household)

JOINING IN THE MIDDLE OF THE YEAR?
Dues are prorated as follows:




If you are joining in the month of:                  Send in this amount for:

                                                     INDIVIDUAL       FAMILY

                                    January            $12             $24
                                    February           $11             $22
                                    March              $10             $20
                                    April              $9              $18
                                    May                $8              $16
                                    June               $7              $14
                                    July               $6              $12
                                    August             $5              $10
                                    September          $4              $8
                                    October            $3              $6
                                    November           $2              $4
                                    December           $1              $2


Make your check payable to: M.A.C.M.

and mail it along with this completed application to:

Maine Academy of Country Music
Membership Application
PO Box 477
Clinton, ME 04927-0477


The Monthly UpBeat Newsletter is available by email to help save costs

WOULD YOU LIKE TO RECEIVE YOUR UPBEAT VIA EMAIL:   YES:___   NO:___



ARTISTS PLEASE COMPLETE THE FOLLOWING:

Check all that apply:

Vocalist:___   Musician:___   Songwriter:___   Comedian:___

INSTRUMENTS PLAYED:

Guitar:___   Dobro:___   Banjo:___   Bass:___   Steel:___   Keyboard:___

Fiddle:___   Drums:___   Other(please describe):________________________

Are You Affiliated with a Band: YES:___   NO:___

If Yes:  Name of Band:__________________________________________________

         Contact Name & Number:_________________________________________

         Band EMail:____________________________________________________


THANK YOU VERY MUCH FOR YOUR SUPPORT!