KENTUCKIANA BLUES SOCIETY Membership Application or Join On-Line from the Front Page

___ Single - $15.00 per year (Funds are US $)
___ Double - $20.00 per year (2 people @ same address gets 2 cards and 1 newsletter)

Date: _______________ 

Name(s): __________________________________________

           __________________________________________

Address: __________________________________________

City, State  Zip: ____________________________________

Telephone (optional): _________________________________

Email: _____________________________________________

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:

____________________________________________________________________

____________________________________________________________________

Print and fill out this form, then send it with your Check or Money Order:

Kentuckiana Blues Society, Inc.
PO Box 755
Louisville, KY  40201-0755

Printed from The Kentuckiana Blues Society Web Page @ http://kbsblues.org/
Last Revised: 01 Jan 2008