Membership Application (Associate)

 

Associate
Membership Application Form

Please
fill out and print:
 
Today’s
date:
Applicant’s
first name:


Applicant’s
last name:


Applicant’s
e mail addr:


Applicant’s
address:


City:

State:

Zip:

Applicant’s
phone#:


Name
of Business or Organization (if applicable):
Business
Address:


City:

State:

Zip:

Business
phone#:
Business
e mail:


NOTE:
Associate Members are not eliglible to vote in AMTL elections, hold
AMTL offices or submit student performer applications for AMTL events.
Signature
of Applicant:

Please
print and send to:

Carol Dovan
AMTL Membership Chair
6 Hillview Ave.
Port Washington, NY 11050

Yearly
dues $35 Payable Annually

Please submit with application form

 

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