| Print and Mail to: BCMOA 4819 Warminster Dr. Columbus,Ohio 43232 614-866-7573 |
| __ New Membership __ Renewal Membership __ Information Change Please Print All Information |
| Last Name ___________________________ First Name __________________________ Middle ____ |
| Address ____________________________________________________________ Apt/Suite _______ |
| City ____________________________________ State ____________________ Zip code ___________ |
(Home) __________________________________ ( work/cell ) _________________________________
| D.O.B. _______________ Age ________ Profession _______________________________________ |
| Web Page URL ______________________ E-Mail Address __________________________________ |
| MEMBERSHIP CATEGORIES All minors must be sponsored by an adult member |
| ARTISTS and/or MUSICIAN -- Performers Only |
| __ Country Artist/Musician $10.00 __ Gospel Artist/Musician $10.00 __ Bluegrass Artist/Musician $10.00 |
| OFFICIAL USE MEMBERSHIP #: _______________ Date Accepted: ______________ Date Paid: _____________ Amount Paid: ____________ Money Order/Cash |
| __ GENERAL PUBLIC Individuals Membership $10.00 |
I agree with the goals of the Buckeye Country Music Organization of America.
This membership is subject to approval and is an annual membership
agreement. The B.C.M.O.A. is an affiliate of the North American Country
Music Association International, Inc.
This membership is subject to approval and is an annual membership
agreement. The B.C.M.O.A. is an affiliate of the North American Country
Music Association International, Inc.
Signature______________________________________________________ Date ________________ minor |
Signature______________________________________________________ Date ________________ |