Membership Application Form

I, the undersigned hereby apply for membership in the above stated Local of the American Federation of Musicians of the United States and Canada (A.F. of M.). I affirm that all statements made in the Application are true and complete. I agree that, at the option of Local, I shall forfeit my membership and all monies paid therefore if I deliberately furnish any false information herein.

Name*

First NameLast Name

Social Security No.*

Birth Date*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Home Number

Area CodePhone Number

Cellular Number

Area CodePhone Number

Work Number

Area CodePhone Number

Website

Please choose below what best applies to you.

I am joining as a new AFM MemberI am a member with another local, and wish to join Local 72-147I am a University student and would like to apply for the student discountI am below the age of 21 and would like to join as a Youth MemberMy band is joining together at this time, and I would like to receive the "Band Joining" discount

US Citizen*

YesNo

If no, type of visa

Are you currently an AFM member?*

YesNo

If yes, enter Local No.

If a former member, how and when was membership terminated?

Principal Instrument*

Other Instrument Played

Are you currently a member of a musical group?

YesNo

If so, what is the name of the group?

Please Read Terms and Conditions:

I pledge to abide by all Rules, Regulations, and Bylaws of the A. F. of M. and the Local stated above. I agree to pay all dues and assessments (including work dues on all musical services performed) required by those Bylaws. I further agree to complete any orientation or indoctrination required by the Local within the time specified by its Bylaws. I authorize the American Federation of Musicians and the above-named Local to act as my collective bargaining representative with full power to execute collective bargaining agreements with employers governing terms and conditions of employment.

Authorization For Check Off Of Work Dues

To: All Employers of My Musical Services.

I hereby authorize and direct you to deduct from my pay and to remit to Local 72-147 of American Federation of Musicians of the United States and Canada (hereinafter called "Federation"), to all other Local Unions of the Federation, and to the Federation, from any wages earned by me as your employee (in my present or in any future employment by you) those membership work dues, or the work dues equivalent, of a percentage of my earning which I am required to pay, and at the times I am required to pay, pursuant to the Constitution and/or Bylaws of said Local Union and/or the Federation.

This authorization, direction and assignment shall be irrevocable for the period of one (1) from the date hereof, or until the termination of any applicable collective bargaining agreement which is in effect between you and said Local Unions and/or the Federation, whichever occurs sooner, and shall automatically renew itself and be irrevocable for successive annual periods or for the period of each such succeeding applicable collective bargaining agreement, whichever shall be shorter, unless written notice is given by me to Local Union NO. 72-147 or to the Federation at least thirty (30) days prior to the expiration of any one (1) year period or at least thirty (30) days prior to the expiration of any applicable collective bargaining agreement, whichever occurs sooner.

Do you agree with the terms and conditions?*

Yes, I agree.

Signature

Name*

Signature date*

New Members will owe ONE TIME initiation fees and a first payment of membership dues. A 3.5% processing fee is added for online payments.

New Membership Fees: Initiation Fees - $165 + 1st Six Months Dues - $70 (processing fee will be included)$243.23

New Membership Fees: Initiation Fees - $165 + 1st Year's Dues - $135 (processing fee will be included)$310.50

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Local 72-147 Membership Application

Please Read Terms and Conditions:

Authorization For Check Off Of Work Dues

Payment