Membership Application

Northwest Chapter

Western Music Association
P O Box 208
Nezperce, ID 83543

208-937-2352
larry@cowboyentertainer.com

Member Name___________________________________________________________

Address:________________________________________________________________

City____________________________ST.___________Zip_______________________

Phone________________________________Fax_______________________________

E-Mail_______________________________Web Site___________________________

Membership Category:

Performer (individual or group)

{ } singer { } instrumentalist { } songwriter
{ } cowboy poet { } humorist { } western actor
Professional

{ }artist { }author { }perf./manager
{ } talent agent { } talent buyer { } promoter
{ } producer { } recording studio { } record company
{ } CD manufacturer { } merchandiser
{ } Media/ public relations { } Radio TV { } Publication
{ } Museum { } Historian { } Publication
{ } Fan { } Other_______________________________
Chapter Dues: Chapter membership dues will be in addition to national membership dues ( to WMA) and shall apply as follows for all categories of membership>

{ } Individual ($10)
{ } Family ( $15)
{ } Performing Group ( $25)
{ } Business Membership ( $60)
{ } Patron Membership ( $50)
{ } Life Membership ( $150)
{ } Sponsoring ( $250)
All members of the Northwest Chapter of the WMA receive copies of the By-Laws of the national organization, the Chapter, and the Chapter Mission Statement