Individual Membership Form Secure membership registration available online at www.pas.org Please complete and return all three pages of the membership form. Member Information Have you ever been a PAS member before? p Yes, Member # _________ p No Prefix _____ First Name __________________________ Middle Initial _____ Last Name_____________________________ Suffix _____ Designation ______________ (PhD, AMTA, CBMT, etc.) Informal Name ________________________________ Gender _____ Date of Birth _____/_____/_____ p Professional Membership p Student Membership Current Grade: p College/University: Undergraduate ____________________________________________________ p Middle School p College/University: Graduate Organization/Company/School Name p High School p College/University: Post-Graduate ______________________________________________________ ______________________________________________________ Title School Name Mailing Information Primary Address p Home p Work p Alternate Secondary Address p Home p Work p Alternate Use this address for: p Mail p Billing p Shipping Use this address for: p Mail p Billing p Shipping Address ______________________________________________ Address ______________________________________________ Address ______________________________________________ Address ______________________________________________ City__________________________________________________ City__________________________________________________ State ________________________________________________ State ________________________________________________ Zip/Postal Code _______________________________________ Zip/Postal Code _______________________________________ Country ______________________________________________ Country ______________________________________________ Communication Work Telephone ______________________________________ Fax __________________________________________________ Home Telephone ______________________________________ Email ________________________________________________ Mobile Telephone _____________________________________ Alternate Email ________________________________________ Website ______________________________________________ Alternate Website _____________________________________ Please remove my name from the following PAS methods of communication: p PAS Email Newsletters p Chapter Communications p PAS Announcements p Industry Mailings* *PAS makes member addresses (excluding telephone and email) available to vendors who provide products and services to the PAS community. We are committed to delivering relevant information and resources to our members. By answering these questions, you will help us target member benefits and communication to your interests. What are your interests and specialties? Select all that apply p Career Development p Health/Wellness p Percussion Ensemble p Symphonic/Orchestral p Composition p Keyboard Percussion p Recreational Music p Technology p Contests/Competitions p Marching Percussion p Research p Vintage/Collector p Drum Circles p Military Ensemble p Scholarships/Grants p World Music p Drumset p PAS Museum/Library p Steel Band p Other ___________________ p Educator Resources p PASIC p Student Resources In which activities do you currently participate? Select all that apply p Clinician p Indoor Marching Percussion p Research p Symphony/Orchestra p Community Band/Orchestra p Jazz Ensemble p Rock Band p World Music Ensemble p Concert/Symphonic Band p Marching Band p Soloist p Other ___________________ p Drum Circle p Percussion Ensemble p Steel Band p Drum Corps p Recreational Music p Studio/Technology Which activities do you currently teach/conduct? Select all that apply p Community Band/Orchestra p Indoor Marching Percussion p Recreational Music p Studio/Technology p Concert/Symphonic Band p Jazz Ensemble p Research p Symphony/Orchestra p Drum Circle p Marching Band p Rock Band p World Music Ensemble p Drum Corps p Percussion Ensemble p Steel Band p Other ___________________ PAS needs volunteers throughout the year to fulfill its mission. What are your volunteer interests?Select all that apply p Audio/Visual p Committee Participation p Judge/Adjudicator p PAS Museum/Library p Chapter Organization p Fundraising p Logistics p Photography p Clinician p Hospitality p PASIC (PAS Museum/PASIC) What is the highest education level you’ve completed? Select one p High School p College/University: p College/University: p College/University: Undergraduate Graduate Post-Graduate p Other ___________________ What type of educator are you? Select all that apply p Early Childhood p Middle School p College/University: p Percussion Specialist Undergraduate p Elementary School p High School p College/University: Graduate p Private Instructor and Post Graduate What was your primary area of study in college? Select all that apply p Composition p Music: Business p Music Education: Other p Performance: Percussion p Ethnomusicology p Music: General p Music Therapy p Performance: Other p Fine Arts p Music Education: Percussion p Other _____________________ Membership Type Select one ePAS: ePAS memberships provide online access to all PAS publications and resources. Hard copy: Hard copy members will receive PAS publications in the mail in addition to online access to all PAS publications and resources. p Student Memberships p ePAS $35.00 Full-time students at all educational levels. p Hard copy $60.00 p p Professional Memberships p ePAS $60.00 Anyone in a percussion-related career or who has an interest in drums and percussion p Hard copy (educators, artists, etc.) p Hard copy $100.00 p Senior Citizen Membership $60.00 Professional hard copy membership for anyone 65 years and above. p Friend Membership For PAS advocates. Membership includes one Professional hard copy membership, a $175.00 $75 tax-deductible donation to PAS, and recognition in each issue of Percussive Notes. Charitable Donations Through your additional financial support, PAS will continue to develop member benefits and award more than $35,000 each year to percussion students throughout the world. Please consider tax deductible donations to any of the funds below: PAS Funds and Scholarships PASIC Scholarship Funds PAS Endowment Fund $ _______ Avedis Zildjian Co. $ _______ PAS Library Endowment Fund $ _______ Cloyd Duff $ _______ PAS Museum Acquisitions Fund $ _______ George P. Contreras $ _______ PAS Museum Endowment Fund $ _______ James A. Sewrey $ _______ PAS Museum Operations Fund $ _______ Ludwig Industries $ _______ Ralph Pace Museum Acquisition Fund $ _______ McMahon Foundation $ _______ PAS/Zildjian Family Opportunity Fund $ _______ Maurie and Jan Lishon/Frank’s Drum Shop $ _______ PAS/Remo, Inc. Fred Hoey Remo, Inc. $ _______ Memorial Scholarship Fund $ _______ Steve Ettleson $ _______ PAS/Sabian, Ltd. Larrie Londin Thomas Siwe $ _______ Memorial Scholarship Fund $ _______ Val and Venus Eddy $ _______ PAS/Armand Zildjian Scholarship Fund $ _______ William F. Ludwig, Jr. $ _______ Yamaha Corporation of America $ _______ Payment _____ Check/Money Order [Make checks payable to Percussive Arts Society. U.S. funds drawn on a U.S. bank only] Membership $________ _____ VISA _____ MasterCard _____ Discover _____ American Express Donation $________ Name on Credit Card ___________________________________________________________ International Card Number __________________________________________________________________ Shipping $________ Expiration Date _____________/____________ CID Code (3-4 digit code) ______________ (Outside North America) Signature ______________________________________________________________________ Standard: $10.00 Please indicate how you received this application form Priority Air: $30.00 ________________________________________________________________________________ Please allow 2 to 4 weeks for processing. Dues to the Percussive Arts Society are not deductible as charitable contribu- Total $________ tions for federal income tax purposes. However, PAS dues may qualify as business expenses subject to restrictions im- posed by the Internal Revenue Code. Donations to the Percussive Arts Society are tax deductible as allowed by the IRS. Online: www.pas.org/join . Mail: 110 W. Washington Street, Suite A, Indianapolis, IN 46204 Phone: 317.974.4488 Fax: 317.974.4499.