LAS VEGAS BLUES SOCIETY MEMBERSHIP FORM



Membership Information:

Name:
Address:
City:
State:
Zip:
Home Phone:
Cell:
E-Mail:


2nd Member Name:
2nd Member Cell:
2nd Member E-Mail:

Membership Type:


$25 Individual:
$45 Family:
$45 Organization Membership (includes businesses and bands):
$125 Contributing Membership:
$525 Benefactor Membership:

Please tell us about yourself. Are you a musician? If so, what instruments do you play? What band(s )are you in?



Your Occupation:
Your Birthday(month/day):


2nd Member Occupation:
2nd Member Birthday (month/day):

Please Select Free T-Shirt Size:

Men's L:
Men's XL:
Men's 2X:
Men's 3X:

Women's 'Baby T' M:
Women's 'Baby T' L:
Women's 'Baby T' XL:
Women's 'Baby T' 2X:

Can we ask you to volunteer some time at a future event?:
Can you help collect blues calendar information for our website?:
Can you help write CD, DVD or show reviews for our website?:

Is there something else you would like to volunteer to do?:

Thank You!