New/Rejoin/Renewal Membership Application Mailing

Membership Application Mailing Form

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

PrefixFirst NameLast Name
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
New Address:*

YesNo
E-mail:*
example@example.com
Phone Number:*
Membership Status*

NewRejoiningRenewing

Signature Page
Audition Center (or nearest metropolitan area):
Piano study with:
Where studied and degree (if any):
Number of years teaching piano:
New Member Referral by:
Rejoining Members: Please indicate name under which previous membership appeared: Type previous name*
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 $90.00 (USA), Associate (for retired piano teachers) Membership (USA) $70.00; $100.00 (Canada and Mexico), Associate (for retired piano teachers) Membership (Canada and Mexico) $80.00; $115.00 (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

Membership Dues Page
Guild Membership Dues (7/1 - 6/30, annually):*

Active Membership (USA) $90.00Faculty Membership (USA) $90.00Associate (for retired piano teachers) Membership (USA) $70.00Active Membership (Canada & Mexico) $100.00Faculty Membership (Canada & Mexico) $100.00Associate (for retired piano teachers) Membership (Canada & Mexico) $80.00Active Membership (outside USA, Canada & Mexico) $115.00Faculty Membership (outside USA, Canada & Mexico) $115.00Associate (for retired piano teachers) Membership (outside USA, Canada & Mexico) $95.00
Dues: ($):*
Mailing Payment Page
Mailing Payment Total ($):*
Mail the printed Form along with a single check or Money Order to:

AMERICAN COLLEGE OF MUSICIANS,

P.O. Box 9469,

Austin, Texas 78766-9469

Check or Money Order received without the appropriate Form will NOT be processed until the applicable Form is received. A Form received without the Money Order or check (with an unsigned check or post-dated check) will NOT be processed until payment is received.
Should be Empty:

Signature Page