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In addition to supporting country music and dance on
Long Island, membership in the Long Island Country Music Association has
numerous benefits.
* Reduced admission at LICMA
dances.
*
Discounts at other Country Music Association dances.
*
Discounts at western wear stores.
*
Six issues of the Pony Express.
Act now to join, print out this page, fill it out and
mail it to us with the appropriate payment included. So don't
delay - Join us today!
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For
ease of legibility, Please
Print |
| Full Name(s): |
| New Membership
Membership Renewal (circle
one) |
(Circle
one)
1-Year Individual Membership: $20.00/person
2-Year Individual Membership: $40.00/person
1-Year Couple Membership (same household): $30.00/couple
2-Year Couple Membership (same household): $60.00/couple |
| Referred by (name): |
| Street Address: |
| City:
State:
Zip: |
| Birthday(s)
(Month/Day): |
| Occupation(s): |
| Home Phone: (
)
Work Phone: ( ) |
| Email Address: |
| Are you interested in Volunteering?
Y / N
(circle
one) |
Would you like to receive the Pony Express
via Email? Y / N
if so, please make sure your email
address is entered above. |
| Today's Date: |
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FOR LICMA
OFFICE USE ONLY
Deposited:
___________________ Card Mailed: ____________________
On Computer: ________________ Newsletter Mailed:
___________________ |
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Mail
this completed Membership Application to:
Long Island Country
Music Association, Inc.
P.O. Box 0872
Commack, NY 11725-0872
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