ASSOCIATION OF PIANO TEACHERS OF LONG ISLAND

MEMBERSHIP APPLICATION

Send this completed application form with  $45 annual dues as directed below.
If received by October 1st, your name will appear in the Membership Directory.

 

DATE:________________________________________

NAME:________________________________________

ADDRESS:_____________________________________

_____________________________________

PHONE NO:____________________________________

e-MAIL:_______________________________________

 

Instrument/Voice:_______________________________

Do You Teach?   ___________ Yes        _________ No

If yes, where? __________Home/Studio _____________ Student's Home

Are You a Concert Performer?  _________ Yes __________ No

Name any other professional music organizations to which you belong.

_________________________________________________________________

_________________________________________________________________

Make your dues check for $45 payable to "APTLI" and mail it with this application to: