APPALACHIAN CULTURAL MUSIC ASSOCIATION
    500 Gate City Highway, Suite 140
    Bristol, VA 24201
 
    Membership Application

    Date____________________________

First Name:_______________________Last Name:_______________________

Spouse

Name:___________________________

Mailing

Address:______________________________City:_______________________

State:____________________________Zipcode:________________________

Phone:__________________________________________________________

E-Mail:__________________________________________________________

Volunteer for ACMA Committee?     YES        NO      (circle one please)

If you circled yes above, please circle committees you are interested in:

Programming/Publicity        Membership     Newsletter      History    

Hospitality     Any         

Instruments Played:________________________________________________

Band Name:______________________________________________________

May we include your name and contact information when we publish the ACMA
membership directory?      YES         NO    (circle one please)

Individual Membership:  $15.00 annually

Family Membership:  $25.00 annually

Make Checks payable to: ACMA