Georgia Music Center Talent Application

Talent Application

Act/Band Name

Management Company

Primary Contact Person

Mailing Address

City

State

Zip

County

Phone1

Phone2

Fax

Email

Websites

Band is based in what Georgia City

	Booking Agent	Record Label	Publishing Company
Company
Contact/ Title
Mailing Address
City
State
Zip
Phone 1
Phone 2
Fax
Email

Music Genres: Limit 2

Band Member	Instrument	BirthPlace	Birth Month






Affiliations	NARAS member	BMI	SOFRAS
	AFM member	SESAC	NABFEME
	ASCAP	SOCAN	Other1
	ASCAP	SOCAN	Other2

No. of Permanent Band Members:

Survey: Which would you prefer to use (only One)
A printed copy of the Directory
A searchable version on the GA Music Website
I don't have Internet Access

I have read the Terms of Participation and Disclosure. I certify that I'm at least 18 years of age: