ASSOCIATION OF PIANO TEACHERS OF LONG ISLAND

Membership Application

www.pianoteacherslongisland.com

          DATE  __________________________

          NAME _______________________________________________________________

          ADDRESS____________________________________________________________

          _____________________________________________________________________

          PHONE ______________________________________________________________

          E-MAIL______________________________________________________________

          INSTRUMENT/VOICE _________________________________________________

          TEACH IN:

                       HOME/STUDIO:          _______   YES           ________     NO

                       STUDENT'S HOME:   ________  YES           ________     NO

                       SCHOOL:                    ________  YES           ________     NO

                       STORE:                        ________  YES           ________     NO  

          CONCERT PERFORMER:       ________  YES          ________     NO 

          SPONSOR ONLY:                   ________ YES           ________     NO  

            Dues are $40 per year, .Make check payable to  "APTLI" and mail it with this application to:

Gwendlyn Ronis,  819 Broadway #3K, Woodmere, NY 11598

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