New MTNA Member Application
Individual membership year begins July 1 and ends June 30.
Student Membership year begins Oct. 1 and ends Sept. 30.
You must belong to National, State, and Local to participate in Competitions, workshops, etc.
Name: ___________________________________ Phone: ____________________________________
Address: _________________________________ Email: ____________________________________
____________________________________ Birth date:__________________________________
Teaching Fields: ___________________________ Sex: _____ Male _____ Female
If student, current year of study _____ Freshman
_____ Sophomore _____ Junior Primary Teaching Situation: _____ N independent
_____ Senior _____ Master's _____R Other _____ C College* _____ S Student
_____ Doctorate _____ Other
* At which Institution? ______________________
Membership Dues
_____ N New Active Member MTNA Dues ($55.00) _______
_____ S Student member PMTA Dues ($30.00) _______
_____ F Foreign member CPMTA Dues ($15.00) _______
_____ P Patron member Student Dues ($1.00) _______
Total Enclosed _______
Credit Card _____ Visa _____ Mastercard _____ American Express
Expiration Date: _____________ Card Number: ______________________________________________
Signature: _______________________________________ Date: ________________________________
Mail Application to: MTNA, Dues Processing Division , P.O. Box 740648, Cincinnati, OH 45274-0648
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Central Pennsylvania Music Teachers Association