Date ____________
Name ___________________________________________
Address ___________________________________________
___________________________________________
ZIP code ________________
Phone (_____)______-____________
email ________________@______________________
Type: ____ Indivdual ($20) ____ Family ($30)
____ New ____ Renewal ____ Address change
If you would be interested in becoming an active volunteer,
please indicate what area(s) you would be interested in:
___ Blues in the School program
___ Membership / volunteer committee
___ Merchandizing committee
___ Marketing / Advertising committee
___ Newsletter
___ Programs committee
___ Web site committee