Connecticut Professional Disc Jockey Association
365 Hills Street East Hartford, CT 06118
Phone (203) 206 - 8185 efax (425) 671- 5278

Membership Application

Date: __________________________ Years In Business: ___________________
Name:_________________________ Company Name:_____________________
Address:___________________________________________________________
City:_______________________________ State:______ Zip Code: ___________
Telephone:_________________Pager:_________________Fax:______________
Email address: ___________________________ D.O.B.:___________
Website: _______________________________________
Fee Per Engagement: 4 Hours: ____ 5 Hours: ____ Extra Hours: ____
Deposit Per Engagement: _____
Do you use a contract? Y: N:   Do you mail literature? Y: N:  Do you have liability insurance? Y: N:
# of shows you perform at per year?: ____   # of shows you would like per year?: ____
Do you wear a tuxedo? All: ____ / Some: ____ / None: ____ Specify Below
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Jobs you prefer to do: _____________________________________________
Jobs you refuse to do: _____________________________________________
Places you will not play: ____________________________________________
Distance you will travel: ____________________________________________
Describe your show: _______________________________________________
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(If you need more room - attach separate sheet)
Equipment Profile (Make, Model, Year Purchased)
Amplifiers: _______________________________________________________
Equalizer/Sound Enhancement: _____________________________________
Mixing Board: ____________________________________________________
Turntables: ___________________ Tape Decks: ________________________
Speakers:________________________________________________________
CD Players:____________________________ Mini-Disc/DAT/MP3:_________
Microphones: _________________________Any Props:__________________
Music: # of CD’s: __________ MP3’s:__________
Tapes/MD’s:__________ Albums/45’s:_________
Other:____________________________________________________________
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"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if accredited, falsified information on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein."
Signature: ______________________________________ Date: ______________

Complete application and submit to: CPDA 365 Hills Street East Hartford, CT 06118
Please include three references: Two professional references (ex. banquet manager, photographer, videographer) plus One bride and groom reference from a recent wedding.
Please also include a copy of your contract.
Thank you for your interest in The Connecticut Professional Disc Jockey Association (CPDA)