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American Orff-Schulwerk Association Membership Form:
Regular member: _____ One year $70.00 _____ Three years $180.00 Student member: _____ $35.00 Regular privileges for full-time student (Please include copy of current ID) Retired member: _____ $47.00 Regular privileges for those 55 or older and retired I have added a tax-deductible contribution to support: _____ AOSA endowment Fund ____ Shield-Gillespie Scholarship Fund ____ Gunild Keetman Assistance Fund ____ Training and Project Fund _____International Outreach Fund Total due: __________ Method of payment: ___ Check enclosed payable to AOSA ___ Master Card ___ Visa ___ AMEX ________:_________:_________:_________ Expiration date: _________ Charge to my account as indicated to be paid accordingly to the current terms of this account. Authorized signature: ______________________________________ Name: ______________________________ Address: _____________________________ City/State: _____________ Zip: _________ Phone: ______________ E-mail:_____________ Please complete: ____ Renewal ____ Intermittent Check as applicable: ____ Music specialist ____ Classroom teacher ____ Private ____ Music therapist ____ Student at: ____________________________ ____ General classroom teacher ____ University professor ____ Church musician ____ Other _________________________________ ____ I do not want my name sold to music industry/institutions ____ I do not want to be listed in the directory ____ I do not want my phone number in the directory ____ I do not want my e-mail address listed in the member listing on the website |