New Member Application Form

New Member Application Form

Application For Membership (Minimum Age - 18 Years)
Information Page
Name:*

PrefixFirst NameLast Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail:*
example@example.com
Phone Number:*
Audition Center (or nearest metropolitan area):
Piano study with:
Where studied and degree (if any):
Number of years teaching piano:

Signature Page
New Member Referral by:
I herewith apply for Active Membership in the National Guild of Piano Teachers for the Type Year* fiscal year, ending June 30th thereof, for which I am enclosing the annual dues of $85.00 (USA), Associate (for retired piano teachers) Membership (USA) $65.00; $95.00 (Canada and Mexico), Associate (for retired piano teachers) Membership (Canada and Mexico) $75.00; $110.00 (outside USA, Canada & Mexico), Associate (for retired piano teachers) Membership (outside USA, Canada & Mexico) $90.00. Dues are nonrefundable.
Signature:*

Clear
Signature Date

MonthDayYear

Hour MinutesAM/PM Option

Signature Page