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Please fill out the form below and click the "Submit" button (at the bottom).


Membership Type

Single ($30 / year)_________ Two Adults ($40 / year)

Student ($25 / year; requires Student I.D.)

Lifetime, Single ($400)

Lifetime, Family ($500)

International Membership Surcharge ($10)


Membership Information

Member Name:
Occupation:
Telephone:
Street Address:

E-Mail Address: (required)
Are you renewing Membership?_ Yes ___ No

Instruments you play:
Are you in a band?_ Yes ___ No


Co-Member Information

Member Name:
Occupation:
Street Address:
City, State, Zip
E-Mail Address:
(Required)
Instruments you play:
Are you in a band? Yes ____ No


Volunteer Interests

Activities Committee _____ Blues in the Schools
Archives Committee ____-_ Festival Committee
Website Committee ______ Concessions
Publicity Committee ___-__ Wherever Needed

Other

Are you willing to be called by phone?__ Yes __ No

Referred by:


 


 
Blues Foundation














 
         
         

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