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2023 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 and Last
Home Phone: (xxx) xxx xxxx
Business Phone:
Cell Phone:
 * Street Address 1:
Street Address 2:
 * City  - State
 * Zipcode  - Country
Email: (All correspoindence will be sent to this address unless US Mail is requested below)
Occupation:
Health Care Speciality: (if applicable)
 * New Member:  Yes  No
Gender: Male  Female  Non-disclosed
Musical Experience (new member)
Please indicate if you can serve as soloist, section leader or principal.
Please indicate your performance status: * Vocalist  Instrumentalist  Companion
Voice: S1 S2 A T1 T2 B1 B2 NA
Instrument:
How did you hear about us?
I prefer to receive updates by (Check One): E-Mail  USPO
Any Special Requiements?
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. MMG concerts are videotaped for broadcast. By registering, you consent to being videotaped. NOTE: Registering On-Line is preferrable!.

  Please check which concerts you will participate in:
 * Veterans Day Concert
Nov. 10, 2023 (may change)
Location (TBD)
  Yes No  
Overseas Concert Tour: (TBD) Yes No

 
  Registration Fee (Yearly):  $ 100.00
   
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. MMG concerts are videotaped for broadcast. By registering you concent to being videotaped.

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




   
National Medical Musical Group is not a government agency.
Last revised: February 08, 2023