New Member Registration Form

New Member Registration Form

Personal Information

Given Legal Name
Given Legal Name
First Name
Middle Name
Last Name
If you prefer to not provide your SSN via this form, please call or visit the LFM Office to provide that info. Your membership cannot be activated without it.
Please provide an email address that you would like listed in the Members-Only directory.
Address
Address
City
State/Province
Zip/Postal
Please write their relationship to you and their name, address, and phone number.

Phone Number(s)

Please provide any phone numbers you would like the LFM Office to have and want listed on the Members-Only Directory

Website/Social Media Profiles

Please list a website or professional social media accounts you would like listed on your profile.

AFM Membership Information

If different from given name.
Are you currently, or have you ever been a member of any Local of the American Federation of Musicians?
Are you currently a member of a band or musical group?
Do you have any agreements with personal manager(s) or booking agent(s)?
Do you teach private lessons?
If you would like to be listed in our directory of music teachers, please select "Yes".
Please select the age range(s) you teach:

Life Insurance Beneficiary

As one of our membership benefits the Local maintains a $1,000 term life insurance policy on each member. Please fill out this information to designate your beneficiary.
Your Permanent Address (Only if different from above)
Your Permanent Address (Only if different from above)
City
State/Province
Zip/Postal
Beneficiary Name (If beneficiary is a married woman, please list her first name, MAIDEN name and last name)
Beneficiary Name (If beneficiary is a married woman, please list her first name, MAIDEN name and last name)
First Name
Middle (or Maiden) Name
Last Name
You may omit the SSN or birthdate if you do not have this information.
(Wife, husband, son, daughter, father, mother, friend, fiancé, etc.)
Beneficiary Address (If different from above)
Beneficiary Address (If different from above)
City
State/Province
Zip/Postal