Membership Survey

This form will be used to update our annual Membership Directory. Please take a moment to provide the information requested below so that we may keep the Directory as current as possible. For EMA Individual, Student, Senior, Family, and Overseas members.

Alternatively, you may also download, fill out and fax to 412-642-2779, scan and email to info@earlymusic.org, or mail back the EMA Directory form for Individual members to 801 Vinial Street, Suite 300, Pittsburgh, PA 15212. Available as an MS Word file (445KB).

All forms must be submitted by Friday, January 3, 2014 in order to be included in the 2014 EMA Directory.

Personal and Contact Information

Salutation:
Name:
Address1:
Address2:
City: State: Zip:
Country:
Phone 1:
Phone 2:
Fax:
E-mail:
Web URL:

Early Music Information

I am an...
Early Music Enthusiast/Audience Member
Early Music Performer/Professional

Level:
Professional
Pre-professional
Semiprofessional
Amateur
Retired

Musicians, please select your instruments(s):

Bowed String Instruments:
Violin
Viola
Cello
Bass
Viola da gamba
Violone
Vielle
Viola d'amore
Other bowed strings

Plucked String Instruments:
Lute
Theorbo
Archlute
Guitar
Harp
Other plucked strings

Keyboard Instruments:
Harpsichord
Organ
Fortepiano
Clavichord
Other keyboard

Wind Instruments:
Recorder
Flute
Oboe
Bassoon
Dulcian
Clarinet
Renaissance winds
Other winds

Brass Instruments:
Cornetto
Trumpet
Horn
Sackbut
Other brass

Percussion:
Percussion

Voice:
Soprano
Alto/Mezzo
Countertenor
Tenor
Bass

Professionals, please select your occupation/role:

Conductor
Historical Dancer
Early Music Educator
Musicologist
Instrument Maker/Repairer
Early music adminstrator (agent, presenter, manager, director)
Music Librarian
Board member or volunteer
Early music publisher or merchant
Writer, journalist, reviewer, editor
Radio, television, recording host or producer
Editor or arranger of early music publications
Theatre, opera director
Composer


Demographic Information:

All demographic information will be kept anonymous and confidential. Aggregate data is used to help EMA advocate for the field of early music and provide accurate information about our constituents to funding sources.

Gender

Female
Male

Age

20 or under
21-35
36-50
51-65
66+

Education

High School
Some College
College Graduate
Masters Degree
Doctoral Degree

Household Income

$10,000 or less
$10,001-$25,000
$25,001-$50,000
$50,001-$75,000
$75,001-$100,000
$100,001 or more

Percentage of Income earned in association with early music:

25% or less
26%-50%
51%-75%
76%+

Occupation


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