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ACCMA Registration Form
New Member & Talent Show Registration
Select One
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Membership Applicant
Talent Show Applicant
First Name
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Last Name
*
Group Name if Group
Email Address
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Address
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Address 2
City
*
State/Province
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Alabama
Alaska
Alberta
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
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District Of Columbia
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Hawaii
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Indiana
Iowa
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Manitoba
Maryland
Massachusetts
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Montana
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New York
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Northwest Territories
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Nunavut
Ohio
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Ontario
Oregon
Pennsylvania
Prince Edward Island
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
Zip/Postal Code
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Phone
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Membership Type
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Artist
Association
Preferred way to contact
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Phone
Email
Any
Check All That Apply
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Artist
Songwriter
Musician
Producer/Engineer
Concert Promoter
Radio Promoter
Talent Agent
Disc Jockey/Media Outlet
Record Executive
Publisher
Comedian
Music Evangelist
Other
Other
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Artist Registration ($199.00)
Talent Show Registration ($150.00)
Name on Card
*
Credit Card Type
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Visa
MasterCard
American Express
Discover
Credit Card Number
*
Expiration Date (mm/yy)
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Terms and Conditions
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