Name________________________________________________
Title or School__________________________________________
Home Address__________________________________________
City______________________ Zip_________________________
                                                                nine digits please

Phone______________________ Email_______________________
                  evening

MEMBERSHIP DUES (July 2011-July 2012)
(Check all that apply)

◊ Active Membership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $80.00
◊ Reciprocal Membership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50.00
◊ Community Partnership available. . . . . . . . . . . . . . . . . . . . . .300.00
◊ Full Time Student Member . . . . . . . . . . . . . . . . . . . . . . . . . . . .50.00
   School & ID#_____________________________________
◊ Retired (55+) Member . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50.00
◊ Individual School Member . . . . . . . . . . . . . . . . . . . . . . . . . . .125.00
◊ District Membership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .700.00
◊ Single Workshop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50.00
◊ Single Workshop for a Full Time Student . . . . . . . . . . . . . . . . .25.00
   School & ID#_____________________________________

◊ First Time Member

CURRENT MEMBERSHIPS
(Reciprocal Members must show proof of chapter membership.)

◊ OCC-AOSA
◊ AOSA
◊ LAC-OASA
◊ SDC-OASA
◊ ICC-OASA
Other________________________

ASSISTANCE

◊ I am willing to volunteer.
◊ I can provide instruments.

Note: If you checked one or both of these boxes, please contact Rocky Brown at 949-249-2048 or email: pianorocky3@yahoo.com.

Make checks payable to : OCC-AOSA

Print & complete form and mail with check to:

Tim Johns
PO Box 1192
Yucaipa, CA 92399
(909) 557-3582