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KENTUCKIANA BLUES SOCIETY
Membership Application
or Join On-Line

___ Single  - $20.00 / year  (All Funds are US $)
Date: _______________ 
___ Double  - $25.00 / year (2 people @ same address - 2 cards and 1 newsletter)  
___ Band  - $30.00 / year (1 Newsletter to 1 address - all members (up to 5) get Membership Cards)
(Include Band Name and all member names)
 
___ Business  - $150.00 / year (1 Newsletter to 1 address - up to 5 Membership Cards, Sponsorship Listing)
(Include Business Name and names for cards)
 
Name(s): ______________________________________________________________
           ______________________________________________________________
Address: ______________________________________________________________
City, State  Zip: ________________________________________________________
Phone (optional): _________________________________________________________
Email(s): _______________________________________________________________
If you are available as a volunteer to work at KBS events, please check here: ___
If you would like to volunteer your services to 
the Kentuckiana Blues Society, please indicate your area(s) of interest:
____________________________________________________________________
____________________________________________________________________

Printed from The Kentuckiana Blues Society Web Page @ http://kbsblues.org/
Last Revised: 20 Jan 2012

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