COLORADO COUNTRY MUSIC ASSOCIATION

540 "B" ST. P.O. Box 759

PENROSE,CO.81240

CCMA MEMBERSHIP APPLICATION

[ ] NEW MEMBERSHIP [ ] INFO CHANGE

Every CCMA, member is eligible for benefits and services provided through the Colorado state organization.

Last Name:_______________________ First:_______________ Middle:___________

Street or PO Box:________________________________Apt./Suite #:______________

City:_______________________________ State:______________ Zip:_____________

Phone: (home)_______________________(work)______________ (fax)____________

Profession:_____________________________ E-Mail Address:___________________

Web Site Home Page:_____________________________________________________

MEMBERSHIP CATEGORIES

[ ] ARTIST-Only for Performers $25.00 annual dues

Musicians [ ] Country [ ] Folk [ ] Bluegrass [ ] Gospel [ ] Artist/Entertainer [ ] Band Leader

[ ] Dance Team/Individual or Cloggers [ ] Writer [ ] Composer

T.V. Country [ ] Actor [ ] Actress [ ] Producer [ ] Director [ ] Comedian

Radio[ ] D.J. [ ] Producer [ ] Director

[ ] COMPANY- For Country Music Businesses $30.00 covers up to 4 employees

Country Nightclubs/Opry [ ] Owner [ ] Manager [ ] Host/Hostess

Music Publishing [ ] Publisher [ ] Owner [ ] Manager

Publications [ ] News Magazine [ ] Owner [ ] Manager [ ] Writer

Recording Companies [ ] Owner [ ] Executive [ ] Technician

Radio/TV Station [ ] Owner [ ] Manager [ ] Program Director

Motion Pictures [ ] Advertising [ ] Sales

[ ] GENERAL PUBLIC- For individuals making a living in/or supporting Country Music $35.00 annualdues

Theme Parks/Auditorium [ ] Owner [ ] Manager [ ] Program Director [ ] Booker

Fairs (Country) [ ] Owner [ ] Manager [ ] Director [ ] Booker [ ] Booking Agent [ ] Representative

[ ] Personal Manager for Country Artist [ ] Business Manager for Country Artist

[ ] Representative for Writer/Composer [ ] BMI, ASCAP, SESAC, NSAI [ ] Union Official

Stores [ ] Western Wear [ ] Record Shop [ ] Owner [ ] Manager [ ] Designer

[ ] GROUPS$40.00 annual dues

[ ] Family [ ] Band/Dance Groups- must notify ASSOCIATION of name changes

[ ] FRIENDS OF COUNTRY MUSIC-For individuals who are not in the Country music business but

support Country Music $40.00 annual dues

I consent to all of the rules and by-laws of the Colorado Country Music Association. This application is for a one year membership

SIGNATURE ______________________________________________________________DATE:________________________

Date Pd._________ Amount Pd._________ Check #___________ Logged__________ First Notice________ Second Notice_______