Name ________________________________ Phone ( ___ ) _________________________

Address ________________________________________ (street address or P.O. Box number)

______________________________________________ (city, state, zip or postal code, country)

My interest in IAMA is based on my involvement as a(n): _______ Professional Musician

_______ Amateur Musician _______ Student

Performing area(s) ___________

_______ Interested Supporter

My involvement in music includes the following: ___________________________________

_____________________________________________________________________________

My present occupation, profession, or position is ___________________________________