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Become a LICMA Member

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.
* Post your upcoming dance events in our online Calendar and Pony
   Express Newsletter.
* Six issues of the Pony Express.

Become a LICMA Member Today!
Join online through Secure PayPal Servers

  1. Fill out the Membership Application form below, then click the Submit button.

Full Name(s):  Required
Street Address:   Required
City:   Required
State   Required
Zip-Code:   Required
Birthday(s) (Month/Day):  
Occupation(s):  
Primary Phone:           Alternate Phone:  
Email Address(es)  Required
Are you interested in Volunteering?:  
Referred by (Name):  

Once all your entered information above looks correct, click the Submit button below to continue:

 

Unable to join online? Print out this form below, fill it out and mail it to us with the appropriate payment included.  So don't delay - Join us today!

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
1-Year Corporate Member: $50.00
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:

FOR LICMA OFFICE USE ONLY

Deposited: ___________________ Card Mailed: ____________________

On Computer: ________________  Newsletter Mailed: ___________________

Mail this completed Membership Application to:

Long Island Country Music Association, Inc.
P.O. Box 0872
Commack, NY  11725-0872