Chapter Friend Information Form

NOTE: All fields that begin with double asterisks (**) are not shown in the Member Directory, but we do keep this information in our database for mailing labels, etc. Names of fields that are followed with a red asterisk (*) are required.

**Title

**Other Title

Name *

First

Last

**Date of Birth (optional)

Education/Certification (check all that apply)

If you have any other Education/Certification abbreviation(s) not listed above, please enter it/them below:

Email *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone # *

Is the phone # above Home or Mobile? *

Home (landline)
Mobile

Primary Position

Name of primary Church/Academic/Other Institution where you play/teach/work

Job title

Institution Address

Address Line 1

Address Line 2

City

State

Zip Code

Office Phone #

Institution website address (URL)

Do you have another position you would like to include in the directory? *

Yes
No

Secondary Position

Name of Secondary Institution where you play/teach/work

Job title at Secondary Institution

Address at Secondary Institution

Address Line 1

Address Line 2

City

State

Zip Code

Office Phone # at Secondary Institution

Website address (URL) at Secondary Institution

Miscellaneous Info

**Name of Spouse or Significant Other, if applicable

Are you available to teach privately?

Yes
No

Which instruments are you available to teach? (Check all that apply.)

organ
piano
harpsichord
other

Other Instruments taught

Would you like to be added to our Substitute List?

Yes
No

The Substitute List is public. It will be made available on our website and in the Member Directory. Updates to the electronic version are made as needed.

Substitute List availability (Check all that apply.)

Weddings
Funerals
Sundays

Headshot for directory

Click or drag a file to this area to upload.

You may submit any picture of yourself here and we will edit to be a headshot. The picture will be used in the membership directory.

**Newsletter mailing preferences *

regular mail & email
regular mail only
email only

**Any comments, clarifications, or additional info we should know?