2026-2027 Country/Western Application COUNTRY/WESTERN CompanyThis field is for validation purposes and should be left unchanged.Instructor’s Name(Required) First Name Last Name This application will be returned if a dance club or business name is listed. Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Cell/Home Phone Number(Required)Other (Optional)E-Mail(Required) Fees listed below include BMI/ASCAP fees, Membership, & Group Limited Liability Insurance beginning April 1, 2026 till March 31, 2027 (Covers background music for classes, dances & local exhibitions)Average No. of different Students or Participants (Weekly) Instructional Use and Dances(Required) 1- 50 ($350.00) 51 - 124 ($560.00) 125-249 ($730.00) 250-374 ($910.00) 375 and over ($1135.00) Consent(Required) I understand that this coverage is for individual dance instructors only and that it does not cover business establishments. Additional Insurance Policies are available for those venues that require such insurance. The Additional Insurance is $125.00 per location and would need to be requested via email or snail mail with the exact name and address as the facility requires.(Required)Signature (Full Name)(Required)By typing my name above, I confirm this serves as my legal signature.Date(Required)One Million Dollar Limited Group Liability Insurance coverage while you are performing or teaching dancing. This is a PACKAGE DEAL and cannot be purchased in part. It includes all licensing, Membership, and Insurance. Fees listed hereon are established by the respective ASCAP/BMI Boards. They are NOT PRO-RATED and NONREFUNDABLE and remain the same for all, or any part of the annual year.Payment Method: Online Payment (3% convenience fee applies) Pay by Check Your total, including the 3% online convenience fee, will be: Price: $0.00 You will be redirected to our secure GoDaddy payment page.Your total amount due is: Price: $0.00 Your check must be received no later than 10 days after you submit this application. After submitting this form, you will receive an email with the mailing address and your application details.If paying by check, the check must be mailed and received within 10 days of the application submission date.Make checks payable to: AMERICAN CALLERS c/o Mac Letson 407 Cox Blvd Sheffield, AL 35660 Office Phone: 256-762-6949 Email: loulet@aol.com macletson@outlook.com Web Page: www.americancallers.net CAPTCHA Δ Share this: Share on X (Opens in new window) X Share on Facebook (Opens in new window) Facebook Like this:Like Loading... Related
