CCMA Application

The Original Most Prestigious Non-Profit Country Music
Organization In The State Of California

The purpose of this organization is to support, organize
inform, and promote all facets of COUNTRY MUSIC,
DANCING, and ENTERTAINMENT

OUR MOTTO: "GOD, COUNTRY & COUNTRY MUSIC"

Statewide Activities Include: Annual Award Shows,
Showcases, Talent Contests, Membership Card, Discounts

Regional Activities Include: Award Shows, Showcases,
Membership Meetings, Newsletter, Banquets - Picnics

JOIN YOUR LOCAL CALIFORNIA REGION
Please check or circle the region of your choice

Los Angeles Region - Los Angeles County, 805-577-8879

Orange Blossom Special - Orange County-Long Beach Area,
714-891-4351

San Diego Region - San Diego County, 619-596-8068


PLEASE FILL OUT THE FOLLOWING INFORMATION FOR MEMBERSHIP

Name:____________________________________________

Address:_________________________________________

City:____________________________________________

State & Zip Code:__________________________________

Phone:___________________________________________

Email:___________________________________________

Entertainer________Business________Fan___________

1 Year Membership / CCMA - \\$25.00
2 Year Membership / CCMA - \\$40.00 save $10.00
3 Year Membership / CCMA - \\$60.00 save $15.00
5 Year Membership / CCMA - \\$100.00 save $25.00
1 Year Band Membership - \\$50.00

For Participation In Your Local Chapter Check Here___

Referred By:_______________________________________

PLEASE PRINT THIS FORM ON YOUR COMPUTER PRINTER FROM
YOUR BROWSER AND MAIL THE COMPLETED FORM AND REMITTANCE
TO:

C.C.M.A.
P.O. Box 30003
Anaheim Hills, CA 92809-0003

For Information Call CCMA STATE OFFICE:714-998-3330

Date Submitted:____________________________________