Name / Mailing Address / Chapter Information

* denotes required field
NAME (first middle last):   
Mailing address:  Please provide only information necessary for mailing.
Institutional affiliation may be added at the Enhanced Member Directory listing.
Street address or PO Box 
Apt. number or Dept. 
Additional info 
(123 N. Main St. or PO Box 1234, not institutional address)
(Apt. 21 or Dept. of Music)
(building name or campus box number)
(Univ. of Maine)
City, State/Province:        Zip or Postal Code: 

Return with no change

* For name change, please contact Katie VanDerMeer at the AMS Office.