Wisconsin -- American Choral Directors Association Membership Application
Print clearly or type. New Membership Membership Renewal - Member Number: ___________________
_____________________________________________________________________________________________________________
First Name Middle Initial Last Name
Home Address
Office Address
Address: _____________________________ Primary Address
  _____________________________
City: _____________________________
State: _____________________________
Zip: _____________________________
Country: _____________________________
Phone: _____________________________
Email: _____________________________
Fax: _____________________________
Address: _____________________________ Primary Address
  _____________________________
City: _____________________________
State: _____________________________
Zip: _____________________________
Country: _____________________________
Phone: _____________________________
Email: _____________________________
Fax: _____________________________
Membership Type (mark one) Choir Types (mark all that apply) Activity Areas (mark all that apply)
Active US/Canada - $ 85
Associate - $ 85
Student - $35
Retired - $45
Institutional - $110
Industry - $135
Foreign Active Airmail - $110
Foreign Active Surface - $100
Life ($200 Installments) - $2000
Installment Amount: $ __________
* Canadian Fees same as U.S.
Boys
Children
Ethnic & Multicultural
Girls
Jazz
Men
SATB/Mixed
Show
Women
* Primary Choir Type __________________
Elementary School
Junior High/Middle School
Senior High School
ACDA Student Chapter
Two-Year College
College/University
Community Choir
Music In Worship
Professional Choir
Supervisor/Administrator
Youth & Student Activities
* Primary Activity ____________________
Statement
Application Submission Instructions
As an ACDA member, I will comply with the copyright laws of the United States of America as they pertain to printed music or the downloading of music off the internet. (Compliance with these laws is also a condition of participation by clinicians and performing ensembles that appear on any ACDA sponsored event or convention.) Please print this application, fill it out completely and remit with a Check, Money Order, or Credit Card in USD (Payable to ACDA) to:
WCDA OFFICE
6802 MILLER RD
ABRAMS WI 54101-9799
Payment Options

Please Select Payment Type:  Check #______________________ (enclosed)     Discover        MasterCard        Visa

Credit Card #: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___      Expiration Date: ___ ___ / 20___ ___ (Month/Year)

 Name of Card Holder: ________________________________________________
(Must be same as member's name)

 Card Holder Billing Address: ________________________________________________________________________________

_________________________________________________________________________________________________________

Signature:________________________________________________________ Date: ____________
I agree to pay above total amount according to card issuer agreement and acknowledge all sales are final unless duplicate payment is made.

Revised November 2005 (c) ACDA