CANADIAN AMATEUR MUSICANS
MUSICIENS AMATEURS DU CANADA		 Membership Application

Renewal. Member #:
New member.

MEMBER (for group memberships, see below)

Family name:
First name:    

INSTRUMENT(S) LEVEL VOICE VOICE LEVEL
1:
2:
3:

SPOUSE OR PARTNER of MEMBER

Family name:
First name:    

INSTRUMENT(S) LEVEL VOICE VOICE LEVEL
1:
2:
3:

CHILDREN (Under 18)

Name Date of Birth Instrument or voice & level
1:
2:
3:

GROUP MEMBERSHIP

Name of group Contact person
(please fill in address information below)

ADDRESS

Street:
Town/city:
Province/state:
Postal/Zip code:
Country:
Day phone:
Evening phone:
Fax:
E-mail:

Language preference: French English

CAMMAC depends heavily on volunteer help from its members. Would you be willing to lend a hand?
Occupation or other expertise or area of interest:

Please do NOT put my name in the CAMMAC directory.

I do NOT wish CAMMAC to include my name in mailing lists occasionally shared with other reputable musical organizations.

REGIONAL AFFILIATION

If you live in Nova Scotia, or within a 100km radius of Toronto, Ottawa/Gatineau, Quebec City or Montreal (excluding the USA), you will be assigned to a region. If you wish to request regional affiliation and do not live in a region, please indicate below.

Region's name:

MEMBERSHIP FEES
Individual member, $35. $
Family (includes children under 18), $55. $
Senior (65 and over), $30. $
Student (full-time), $30. $
Group, $200. $
Sign me up for 2 years. (Double the membership fee)
Do you wish to make a donation to your region? * $
Do you wish to make a donation to CAMMAC's National Office? * $
* Tax receipts provided for donations.
TOTAL AMOUNT $

PAYMENT
Upon receipt of your application, your credit card will be charged the TOTAL AMOUNT from above.

Mastercard
Visa
Name on credit card:
Credit card number:
Expiry date (month/year):

Note: This Membership Application form does not use a secure Web connection.
When you submit this form electronically, all information will be e-mailed in plain text directly to the National Office at
Would you like to be copied on the e-mail sent to the National Office?
(If you check this box, a copy of the e-mail will be sent to the address specified in the field E-mail above)

     

If you prefer not to enter your credit card information, you can print this membership application form, and mail it along with a cheque for the TOTAL AMOUNT to: 

CAMMAC,
85 Cammac Road
Harrington, QC
J8G 2T2
Canada
or call our National Office at (819) 687-3938 or toll-free at 1-888-622-8755 to join immediately!

If you have any problems using this form, please contact