C.C.M.T.A. Membership & Information Form
2011-2012
To become a member of C.C.M.T.A. carefully complete all 3 sections below then click the "Submit Membership Information" button at the bottom of the page. All required fields are marked with a red asterisk. Payment is required to complete the membership process. Please note, this form may not work properly on older versions of Internet Explorer. Thank you for your interest in joining C.C.M.T.A..
If you have already joined C.C.M.T.A. for the 2011-2012 academic year, you may edit your membership information or change your password by signing-in below. You should have already received an email with your login information.
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1. Please select your membership type
required to continue
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Active
($15.00)
- for county school music teachers, required for student participation in CCMTA activities.
Associate
($10.00)
- for non-school music teachers, college faculty, and business owners.
Retired
(free)
- for former county school music teachers.
2. Please provide your name and contact information
* required field
Name
*
First Name
*
Last Name
Middle Initial
Title
* none *
Dr.
Mr.
Mrs.
Ms.
Miss
Mailing Address
*
Home Address
*
City
*
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip
Phone Numbers
*
Primary Phone & Type
* select type *
Home
Cell
(ex. 716-555-1234)
Secondary Phone & Type
* select type *
Home
Cell
(ex. 716-555-1234)
Email Addresses
*
Primary Email & Location
* select location *
School
Home
Business
*
Confirm Primary Email
Secondary Email & Location
* select location *
School
Home
Business
Confirm Secondary Email
Check here if you do not have an email address or do not wish to be contacted via email.
Instruments Played
*
Major Instrument
** select major instrument **
Flute
Oboe
Bassoon
Clarinet
Saxophone
Trumpet
French Horn
Trombone
Baritone
Euphonium
Tuba
Percussion
String: Violin
String: Viola
String: Cello
String: Bass
Voice: Soprano
Voice: Mezzo-Soprano
Voice: Alto
Voice: Tenor
Voice: Baritone
Voice: Bass
Piano
Organ
Keyboard
Guitar
Harp
None
** optional instrument 2 **
Flute
Oboe
Bassoon
Clarinet
Saxophone
Trumpet
French Horn
Trombone
Baritone
Euphonium
Tuba
Percussion
String: Violin
String: Viola
String: Cello
String: Bass
Voice: Soprano
Voice: Mezzo-Soprano
Voice: Alto
Voice: Tenor
Voice: Baritone
Voice: Bass
Piano
Organ
Keyboard
Guitar
Harp
** optional instrument 3 **
Flute
Oboe
Bassoon
Clarinet
Saxophone
Trumpet
French Horn
Trombone
Baritone
Euphonium
Tuba
Percussion
String: Violin
String: Viola
String: Cello
String: Bass
Voice: Soprano
Voice: Mezzo-Soprano
Voice: Alto
Voice: Tenor
Voice: Baritone
Voice: Bass
Piano
Organ
Keyboard
Guitar
Harp
Optional Second Address & Business Information
Secondary Address Dates
Secondary Address
City
State
* select state *
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Business
3. Please provide your professional information
* required field
School District & Buildings
*
School District
** Select your School District **
Bemus Point Central School
Bethel Baptist Christian Academy
Brocton Central School
Cassadaga Valley Central School
Catholic Academy of the Holy Family
Chautauqua Lake Central School
Clymer Central School
Dunkirk City Schools
Falconer Central School
Forestville Central School
Fredonia Central School
Frewsburg Central School
Jamestown Public Schools
Northern Chautauqua Catholic School
Panama Central School
Pine Valley Central School
Ripley Central School
Sherman Central School
Silver Creek Central School
Southwestern Central School
Westfield Academy and Central School
*
Buildings Taught in
(check all that apply)
** you must select your school district **
Bemus Point Elementary
Maple Grove High School
Bethel Baptist Christian Academy
Brocton Central School
Cassadaga Elementary
Sinclairville Elementary
Cassadaga Middle/High School
Catholic Academy of the Holy Family
Chautauqua Lake Central School
Clymer Central School
School #3
School #4
School #5
School #7
Dunkirk Middle School
Dunkirk High School
Fenner Elementary
Temple Elementary
Falconer Middle/High School
Forestville Central School
Fredonia Elementary
Fredonia Middle School
Fredonia High School
Robert H. Jackson Elementary
Frewsburg Middle/High School
Jamestown Community College
Bush Elementary
Fletcher Elementary
Lincoln Elementary
Love Elementary
Ring Elementary
Rogers Elementary
Jefferson Middle School
Persell Middle School
Washington Middle School
Jamestown High School
Northern Chautauqua Catholic School
Panama Central School
Pine Valley Elementary
Pine Valley High School
Ripley Central School
Sherman Central School
Silver Creek Elementary
Silver Creek High School
Southwestern Elementary
Southwestern Middle School
Southwestern High School
SUNY College at Fredonia
Westfield Academy and Central School
School Phone
*
School Phone
ext.
(ex. 716-555-1234)
Subjects Taught
*
Check the grade levels boxes below for each area you teach.
General Music
K
1
2
3
4
5
6
7
8
9
10
11
12
Vocal/Choral
K
1
2
3
4
5
6
7
8
9
10
11
12
Band
K
1
2
3
4
5
6
7
8
9
10
11
12
Orchestra
K
1
2
3
4
5
6
7
8
9
10
11
12
Other Music Classes
Department Chair
Yes, I serve as the Music Department Chair, Coordinator, or Instructional Leader.
School District
*
Former District
** Select your former School District or College **
Bemus Point Central School
Bethel Baptist Christian Academy
Brocton Central School
Cassadaga Valley Central School
Catholic Academy of the Holy Family
Chautauqua Lake Central School
Clymer Central School
Dunkirk City Schools
Falconer Central School
Forestville Central School
Fredonia Central School
Frewsburg Central School
Jamestown Community College
Jamestown Public Schools
Northern Chautauqua Catholic School
Panama Central School
Pine Valley Central School
Ripley Central School
Sherman Central School
Silver Creek Central School
Southwestern Central School
SUNY College at Fredonia
Westfield Academy and Central School
Associate Member Type
*
Please select the appropriate choice below.
I am from a college.
I represent a business.
I am a non-school music teacher.
No additional information is needed.
Business & Job Information
Job Title
*
Business/Company
*
Business Address
*
City
*
State
* select state *
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip
*
Business Phone
ext.
(ex. 716-555-1234)
College & Building
*
College/University
** Select your College or University **
Jamestown Community College
SUNY College at Fredonia
*
Building
College Phone
*
College Phone
ext.
(ex. 716-555-1234)
Title & Subject Information
*
Job Title
*
Class Taught 1
Class Taught 2
Class Taught 3
Class Taught 4