SRSPF Account

Website Registration Form

* Indicates a required field.

*SSN, SIN or TIN:

(numbers only, no dashes or spaces)

*Prefix:

*Legal First name:

*Legal Last name:

Middle name:

Suffix:

Professional Name:

*Sex:

*Date of Birth:

(CCYY)

Marital Status:

*Email:

*Security question:

*Security answer:

Primary Residence Address

or
*Address1:

Address2:

Address3:

*City:

*State/Province:
*US Zip Code:	-

*Non-US Postal Code:
*Country:

Mailing Address

(if different from residence)

or
Address1:

Address2:

Address3:

City:

State/Province:
US Zip Code:	-

Non-US Postal Code:
Country:

Phone Numbers

Home number:	-	-

Work number:	-	-

Cell number:	-	-

Fax number:	-	-

International number:

AFM Locals:

How did you find out about the SRSPF site?

Other:

Be sure to print, sign and mail your membership form to SRSPF:

Sound Recording Special Payments Fund
570 Lexington Avenue 21 Floor
New York, NY 10022-6837

Once the SRSPF has approved your membership, you will receive an e-mail approximately one week after the approval with instructions on how to activate your account.

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