ETSB&OA 2019-2020 Member Registration Form

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** THE LATE FEE OF $150 IS NOW IN EFFECT **

Please read each question and response carefully to ensure you are registering at the correct level of membership and any addition association dues. September 21, 2019 is the deadline for online registration and postmark before late fee penalties will be assessed. If you have any questions, please email Mathew Williams at mathew.williams@gcstn.org.

When finished double check your information to be sure it is accurate. After you have verified your information, click Submit. You will receive a confirmation e-mail with your registration information; return a copy of this e-mail with your payment to:

Mathew Williams - Executive Secretary
1905 Shiloh Road
Greeneville, TN 37745

Check should be made payable to East Tennessee School Band & Orchestra Association (or ETSB&OA).

Only Regular Active Members, Regular Active Spousal Members, and First Year Teacher Active Members who are directors of a school music program are allowed to enter students in any ETSB&OA events.

** NEW **

Please indicate via the last question if you wish to receive an invoice to pay online. You will be responsible for paying any additional fees assessed by the bank for online payment (2.9% of the total plus $0.30).

Leave fields blank that may not apply to you.

Email *

NAfME number - leave blank if unknown

Expiration Date (NAfME number)

Type of Membership *

Regular Active Member - $150.00 + $150.00 late fee

First Year Teacher Active Member - $83.00 + $150 late fee

Regular Active Spousal Membership - $130.00 + $150 late fee

Active Membership WITHOUT NAfME - $15.00 + $150 late fee

College Student Membership - $49.00 + $150 late fee

Retired Member with retired NAfME Membership - $65.00 + $150 late fee

Retired Member without NAfME Membership - $15.00 + $150 late fee

Honorary Lifetime Member with retired NAfME Membership - $50.00 + $150 late fee

Honorary Lifetime Member without NAfME Membership - $0.00

Honorary Lifetime Member with Regular NAfME Membership - $135.00 + $150 late fee

Associate Membership (Businesses Only!) - $25.00 + $150 late fee

First Name *

Middle or Maiden Name

Last Name *

Role - choose one *

Band

Orchestra

Band AND Orchestra

General Music

Private Instructor

Administrator or Supervisor

Retired

Level that you teach *

Elementary School

Middle School

High School

College or University

Not Applicable

School name (leave blank if you do not teach in a school)

School Address - Line 1

School Address - Line 2

School City

School State

School Zip

School Phone (ex. ***-***-****)

Home Address *

Home City *

Home State *

Home Zip *

Mobile Phone - leave blank if you do not have one (ex. ***-***-****)

Landline Phone - leave blank if you do not have one (ex. ***-***-****)

Primary E-mail *

Secondary E-mail - leave blank if you do not have one

Region of ETSB&OA *

Upper

Middle

Lower

Major Instrument *

Do you wish to join TBA (Tennessee Bandmasters Association)? If so, you will charged an additional $25.00 in dues which we will forward to TBA. *

Yes. I understand this is an additional $25.00 fee I must pay.

No, I do not wish to join TBA.

Do you wish to receive an invoice to pay online? (You will be responsible for paying 3.0% of your total plus $0.30 - fee charged by bank, not ETSBOA) This will be sent in a separate e-mail. *

Yes

A copy of your responses will be emailed to the address you provided.

Submit

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