Please print this page, fill out the form, and mail it to address shown below with a check for $30 You have elected to join as an INDIVIDUAL Please use back of form if extra space is required

This box for COMA office use only Member # :   _______________ Date one year membership begins:________________ Amt Paid________   Chk# /date_________ / ________________ On Elist_____   On Website  ____ In QB ______ Cards _______

1) Your name and the name you perform or do business under (if applicable): 

______________________________________________________________________________________

2) Genre of Music: ______________________________________________________________________

3) Your mailing address: _________________________________________________________________

_______________________________________________________________________________________

4) Your E-mail address: _________________________________________________________________

5) Phone(s): _____________________________ Fax: ___________________________

6) Do you have an existing internet site? ___ Yes ___ No. 

If yes, please provide the address: http://_____________________________________

7) Will you provide us with a short (one or two paragraphs) bio or description of 
yourself?     ____ Yes ____ No (if yes please send with this form)

8) Will you provide us with a photograph or copy of cover art? ____ Yes ____ No

9) Will you provide us with a recording (a CD is best) for a sound clip to be used 
on the website in the featured member rotation box?  ____ Yes ____ NO   

Please identify the track to be used and furnish appropriate credits - 

Track # _____ Song Title ______________________________

Author(s) / copyright ___________________________________________________________________

With respect to numbers 7, 8  and 9  above, please advise if you are enclosing the items by mail: _______,
or if you are forwarding them to the webmaster (webmaster@coloradomusic.org) by e-mail _______.

By signing below you grant COMA permission to post your name, likeness and sound clip
 on its internet site and warrant that you have the authority to grant such rights.

 __________________________________________________________________ (Signature)

Please make your check payable to: Colorado  Music Association
Mail to:  1490 Lafayette St. Suite 104B, Denver, CO 80218