Last Name
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Middle (optional)
First Name
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Professional Name/Stage Name (optional)
Social Security Number
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How long at current address?
Date of Birth
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Place of Birth
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U.S. Citizen?
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If not, type of visa
Cell Phone
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Website/URL
I want to receive work dues statements by:
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Email Only Mail Only Both Email and Mail
Are you currently an AFM member?
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If yes, Local Number(s):
If a former AFM member, which Local(s),and how and when was your membership terminated?
Additional instrument(s)/musical occupation(s)
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Name any personal manager(s) or booking agent(s) with whom you have any agreements:
If you are currently a member of a regularly organized musical group, what is the name of the group?
MEMBERSHIP OBLIGATION
I, the undersigned, hereby apply for membership in the above stated Local of the American Federation of Musicians of the United States and Canada (AFM). I affirm that all statements made in this application are true and complete. I agree that, at the option of the Local, I shall forfeit my membership and all monies paid therefore if I deliberately furnish any false information herein.
I pledge to abide by all Rules, Regulations, and Bylaws of the AFM and those of Local 369. I agree to pay all dues and assessments (including work dues on all musical services performed) as required by those Bylaws. I further agree to complete any orientation required by the Local within the time specified by its Bylaws. I authorize the American Federation of Musicians and Local 369 to act as my collective bargaining representative with full power to execute collective bargaining agreements with employers governing terms and conditions of employment.
I further authorize the AFM, in the name of the AFM or in my name, to do all acts, initiate all proceedings, executive, acknowledge and deliver any and all documents and pleadings, litigate, collect, and receive money, and in the AFM's sole judgement, join me as a party plaintiff or defendant in suits or proceedings, or to bring suit in my name or the FM's name, in respect to any AFM collectively negotiated agreement or any statutory royalty or remuneration payment to which I may be entitled under the laws of the United States or other countries or under international law or treaties. I authorize the AFM to offset from any royalties and remunerations collected the reasonable expenses of collecting, administering and distributing those royalties and remunerations.
I also understand that, when the Federation receives any residual payments for a new use of a musical product, the Federation will deposit those monies into a separate interest-bearing account and then will attempt to identify and locate the musicians to whom the payments are due and to distribute those payments to them. In the event that I cannot be identified and located, and I do not file a claim for payment with the Federation within three years after the Federation receives the payment, I authorize the Federation thereafter to transfer the monies due to me to the general treasury to be used to defray the costs of administering and operating the Federation; provided, however, that at any subsequent point I may file a written claim with the Federation and, upon doing so, I shall be entitled to receive the residual payment to which I am entitled (without interest and offset by the applicable Federation work dues) unless the State is then holding the residual payment I am due, in which case I shall apply to the State for my payment.
Date
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Date
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First Name on Credit Card
Last Name on Credit Card
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