Membership Form

Membership
Application

Main Name(s) to head Members Directory Listing
Name(s) of Family Members to list (family membership only)
Name of Contact Person for library, school, business, or corporate membership.
Mailing Address
Day Phone
Evening Phone
Fax
E-mail
Website
Additional Individuals*

* Additional Individuals (other than the contact person) to be listed and cross-referenced to your main directory entry @ $5.00 per name. Example: other people associated with a business or corporate membership, or family member with a different last name. This option not available for library/school members.
Your Closest or Preferred CMN Region
Canada Great Lakes New York Metro	Midwest New England Southern California	Northern California Pacific Northwest	Southeast Mid-Atlantic

Membership Categories *and Fees (US funds only)*
Institution (library/school) $35 Individual/Family $45 Small Business/Nonprofit $60		Corporate $150 Patron $250 and up Please contact the CMN office for details
Outside the US and Canada, add $10 US to all categories If you need scholarship assistance, please contact the CMN national office for information before completing this form.

PAYMENT SUMMARY
Membership Fee	$___________
Additional Names @ $5.00 each	$___________
Donation to General Fund	$___________
Donation to Membership Scholarship Fund	$___________
Total Amount Owed	$___________

___	Check or Money Order enclosed
___	Charge my Credit Card (circle one)
	Visa MasterCard AmEx Discover
	Card Number	__________________________
	Expiration Date	_________
	Signature	__________________________

Please print out this application, fill it in, then mail it to:
The Children's Music Network
P.O. Box 1341
Evanston, IL 60204-1341

In a few weeks we will send you a CMN
Welcome Packet with a form for adding information
to your Members Directory listing.