2018-2019 NW District Registration Form
Please Send Membership Dues to:

Mike Howell, NWDBA Treasurer
Oak Grove High School
3507 Midway School Rd
Winston-Salem, NC 27107

Dues are $15 if postmarked by October 15th
Dues are $50 if sent AFTER October 15th

School or Booster Check Only...Payable to "Northwest District Bandmasters Assoc."
*THIS IS THE ONLY PAYMENT THAT IS SENT TO THE TREASURER*

School Information
If you teach at more than one school, please fill out a separate form for each.
School Name *
Please do not include the "type" of school in this box. That is the next question.
Your answer
Type of School *
Choose one
School Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
School Phone *
No spaces or dashes (ex. 5558675309)
Your answer
Band Room Phone (if different from above)
No spaces or dashes
Your answer
Director Information
First Name *
Your answer
Last Name *
Your answer
Home Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Phone Number *
No spaces or dashes (ex. 5558675309)
Your answer
Email Address *
Your answer
Primary Instrument *
Choose one
NAfME Card Number *
Your answer
NAfME Card Expiration Date *
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