| Name | ||
| Address | ||
| Address | ||
| City | ||
| State | ||
| Zip Code | ||
| Phone | ||
| Credit Card Number | ___  |
|
| Expiration Date | ___  |
|
Printable Application Form
Place an "x" in the box of your choice and fill in the rest of the
information below.
| Senior Citizen (50 & Up) | $15.00 |
Songwriter | $25.00 | |||
Veteran |
$15.00 |
Talent Agency |
$100.00 |
|||
Fan |
$20.00 |
Radio Station |
$100.00 |
|||
Artist |
$50.00 |
Television |
$100.00 |
|||
Musician |
$25.00 |
Advertising Agency |
$100.00 |
|||
Personal Manager |
$50.00 |
Record/Video |
$100.00 |
|||
Country Comedy |
$50.00 |
Theater/Venue |
$100.00 |
|||
Promoter |
$50.00 |
Merchandiser |
$100.00 |
|||
Disc Jockey |
$25.00 |
Affiliated |
$100.00 |
|||
Publication |
$50.00 |
Lifetime Member |
$500.00 |
| Name | ||
| Address | ||
| Address | ||
| City | ||
| State | ||
| Zip Code | ||
| Phone | ||
| Credit Card Number | ___ |
|
| Expiration Date | ___ |
|
You may also pay by Check/Money Orders payable to:
Country
Legends Association
P.O. Box 7171
Duluth, MN 55807-7171
Telephone: (218) 626-9044
Please allow 6 weeks for processing and receipt of
membership.
MEMBERSHIP IS NON-REFUNDABLE