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New & renewing WAAM members who register before August 15, 2005& receive a 15% discount ! Name:_____________________________________________________ Address:___________________________________________________ City:______________________________________________________ State:_____________________________________________________ Zip:_______________________________________________________ Home Phone:_______________________________________________ Work Phone:________________________________________________ Fax:_______________________________________________________ E-mail:_____________________________________________________ Genre of Music:______________________________________________ Circle Whichever Applies Professional
Musician, P/T Musician Number of Participants:_________(1 person $45 / 2-4 persons $90 / 5-6 persons $120 addl $10ea) Showcase Participant (Yes/No):_________ (add $20.00) # of participants_____ Name of Group:_____________________________________________ Vendor (Yes/No):_________ ($110.00 fee - includes 2 participants) Vendor Product or Service:___________________________________ Total amount enclosed:______________________________________ Credit Card Type: Visa___ Discover___ MC___ AMX___ CC#_____________________________ EXP Date: (MM/YYYY)____/______ Signature:_____________________________________________________
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