2018 Membership & Concert Registration
 


[Click Here] for a printable registration form for mailing instead of using this on-line version
 

Please submit one form per person. You may also wish to print a copy of the completed form for your own records.

Personal Information:
*
- Required Fields

 Name* (first)*(last)

*Home #  

Area code   
  -

 Home Address*

 Business  or Cell #  

Area code
-

 City*              State *  

 FAX #  

Area code
-

 ZIP*              E-Mail *   
 Occupation New Member ?  Yes   No
 Health Care Specialty (If applicable) Gender: Male Female
 Musical Experience (if new member) (Please indicate if you can serve as soloist, section leader, Principal)
 How did you hear about our group?
* I prefer to receive updates by (check one)  Email (saves postage)  US Postal
 
 Please indicate your performance status: Vocalist Instrumentalist Companion
Voice: S1S2AT1T2B1B2   Instrument:
 Any Special Requirements?

REGISTRATION FEES
Registration fees are $100.00 annually per individual and are valid for the calendar year in which they are paid. By paying registration fees, you receive mailings, reports, and information and qualify for hotel and other discounts related to U.S. and overseas tours and performances.

  Please check which concerts you will participate in:
  Spirit of 45 Concert (Alexandria, VA)

Aug 12, 2018 YesNo

Please consider making an optional, supporting contribution. You will be prompted after you Foreign Tour(Poland)

 Aug. 13-20 2018  YesNo

submit this form. Optional Tour: (Lithuania & Latvia)

Aug. 20-25, 2018  YesNo

     
   

 

    Dates above subject to change
  Registration Fee (yearly):  $ 100.00
     
Registration fees are refundable if you are not accepted for this years program. Registration is open to VA, non-VA, medical and non-medical individuals. If you need a receipt, please print this page and send to our address below and enclose a stamped self-addressed envelope. For more information, contact us at: (202) 797-0700 or toll free (888) 6-Do-Re-Mi (888-636-7364). FAX: 202-797-0771.

MMG, Attn: Richard Kuntz, 332 River Bend Road, Great Falls, VA  22066-4140


 

Payment Method

Credit Card Personal Check
 


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National Medical Musical Group is not a government agency.
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