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Closest Relative (or other person who will always know your address) not living with you: Name
Are you currently an AFM member? (Required) Have you ever been a member of any Local of the AFM? (Required) Are you currently a member of a musical group or Orchestra? What is your Primary Instrument? (Required) Accordion Arranger/Orchestrator Autoharp Bagpipes Banjo Bass Violin Bass (Electric) Bassoon Bassoon (Contra) Bayan Celeste Cello Clarinet Clarinet (E♭ Sop) Clarinet (Alto) Clarinet (Bass) Composer Conductor Congas Copyist Cornet Dobro Guitar Drums (Set) Dulcimer English Horn Euphonium Flugelhorn Flute Flute (Alto) French Horn Glockenspiel Guitar (Acoustic) Guitar (Electric) Guitar (Other) Guitar (Steel) Harmonica Harp (Concert) Harp (Celtic) Harpsichord Keyboard/Synth Mandolin Marimba MIDI/Programmer Oboe Oboe d'Amore Organ Percussion Percussion (Latin) Piano Piccolo Recorder Saxophone (Sopr) Saxophone (Alto) Saxophone (Tenor) Saxophone (Bari) Saxophone (Bass) Steel Drums Timpani Trombone (Alto) Trombone (Tenor) Trombone (Bass) Trumpet Trumpet (D-E♭-Pic) Trumpet (Bass) Tuba Vibes Viola Viola da Gamba Violin Vocals Xylophone Washtub Bass Librarian Other Select any other instruments you play professionally: Describe your musical skills (check all that apply): What styles of music do you play professionally? Do you do vocals? What type of vocals? Do you teach privately? Do you have a music group or solo that you book? What kind of music? (check all that apply) I have read and agree with the Membership Obligation below. (Required) I agree
I pledge to abide by all Rules, Regulations, and Bylaws of the AFM and Local 99 stated above. I agree to pay all dues and assessments (including work dues on all musical services performed) required by those Bylaws. I further agree to complete any orientation or indoctrination required by Local 99 within the time specified by its Bylaws. I authorize the American Federation of Musicians and Local 99 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, execute, acknowledge and deliver any and all documents and pleadings, litigate, collect and receive money, and, in the AFM’s sole judgment, join me as a party plaintiff or defendant in suits or proceedings, or to bring suit in my name or the AFM’s name, in respect of 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. I have read and agree with the Work Dues Check-off Authorization below. (Required) I agree
I hereby voluntarily authorize and direct any party who engages my musical services to deduct from my compensation for those services the uniformly required dues or fees based on earnings, including work dues and/or agency or service fees, as set forth in the Bylaws of the American Federation of Musicians of the United States and Canada (Federation Work Dues) and/or the dues or fees based on earnings including work dues and/or agency fees, as set forth in the Constitution and/or Bylaws of the Local Union hereof having jurisdiction over these services (Local Union Work Dues). I further authorize, and direct, each such party who engages my musical services to remit promptly all Work Dues thus deducted to the Federation or the appropriate Local Union thereof in accordance with the applicable regulations, and at the times specified in those regulations. Where the payment of either dues or agency or service fees is lawfully required as a condition of employment, said deductions shall be made irrespective of my membership in the Federation and/or the Local Union thereof. This authorization shall be irrevocable for a period of one (1) year from the date hereof or, with respect to any employer having a collective bargaining agreement, until the termination date of the current collective bargaining agreement, whichever occurs sooner. This authorization shall automatically renew itself and be irrevocable for successive annual periods unless I give written notice to the Federation and those Local Unions of which I am a member within the fifteen (15) day period following the expiration of any such annual period or, with respect to any employer having a collective bargaining agreement, within the fifteen (15) day period following the termination date of any such collective bargaining agreement.
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