2017/2018 Membership Application

Law Student Membership

Individual Membership

Mid-Level Business Membership

Corporate Membership

Please print, fill out and remit this form with a check made out to CCC, and send to:

California Copyright Conference

P.O. Box 57962
Sherman Oaks, CA 91413

For assistance or additional information, please call 818-379-3312 (voicemail only) or email info@theccc.org

C C C M E M B E R S H I P A P P L I C AT I O N / R E N E WA L
The applicant agrees to abide by the Charter and By-Laws of the CCC and pay the required
membership fee. The annual membership fee is $35.00 for law students, $55.00 for an individual
membership, $175 for a Mid-level Business Membership or $250.00 for a Corporate Membership.
All memberships are renewable each July.

Name: _________________________________________________________________
(If this is a corporate membership, please include the name of the contact person)

Title: _________________________________________________________________

Company: _________________________________________________________________

Address: _________________________________________________________________

City: _________________________________________________________________

State: ___________________________ Zip Code: ___________________________

Business Phone: ________________________________________________________________

Email: _________________________________________________________________

Business Website: _____________________________________________________________

Referred by: _________________________________________________________________

Opt-in Email Notification: Yes: Check this box ONLY if you wish to receive email notifications of
our monthly meetings and events.

Please indicate which ONE of the following categories best applies to you:

___ Music Publisher ___ Music Supervisor ___ Songwriter ___ Artist ___ TV/Film Producer

___ Music Clearance ___ Attorney ___ Student ___ Accountant ___Record Company ___ Other

Signature: _____________________________________________________________________________