Virginia Country Music Association
P.O.Box 62106, Virginia Beach, VA 23466

Membership Application
First Name:                           Reset Form 
Middle Initial: 
Last Name:    

Street Address: 
State:                         ZIP Code:  

Telephone Number: 

Email Address:         

Performing Musician / Artist     Yes    No

Instruments You Play: 

Affiliated with Country Music:  Yes   No
    How affiliated: 

If accepted for membership, I agree to abide by the Constitution and By-laws of the Virginia Country Music Association, incorporated.

Signature:  _________________________________________________

Annual Dues of $20.00    Must accompany this application.

V.C.M.A.  Use Only

Recommended by:  ____________________________________________

Date of Acceptance:  __________________

Card Number:  _______________________   Expiration Date: _________________