Print this form and mail it the to address at the bottom of page
 

BATON ROUGE BLUES SOCIETY MEMBERSHIP APPLICATION

ANNUAL DUES:

 Student $10    Individual $20    Family $30 

Business $100     Corporate $250
 


DATE: __________ 
NAME: _____________________________________

BUSINESS NAME: _____________________________________

ADDRESS: ___________________________________

CITY/STATE: ___________  ZIP CODE: ____________

HOME PHONE (        ) __________  BUSINESS PHONE (        ) ___________

OTHER PHONE (        ) ___________

E-MAIL: ___________________

ARE YOU A MUSICIAN? ______      NAME OF BAND: ______________

WHAT INSTRUMENT DO YOU PLAY? _______________________

HOW DID YOU HEAR ABOUT THE BRBS? _______________________

ARE YOU INTERESTED IN VOLUNTEERING? ______________

ANY COMMENTS OR SUGGESTIONS? ________________________

 

Complete application and mail with check or money order to
BATON ROUGE BLUES SOCIETY
P.O. BOX 65378
BATON ROUGE, LA  70806-9998

 


____________________________________________________________________________________
For Office Use Only:

date received: _________ received by: __________

amount received: __________ card no. __________

card sent: __________ expiration date: __________

 

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