SCV Blues Society Membership Form

Member Name

Street Address

City, State, Zip

Home and Cell phones

Occupation

Email Address

Interest in Society

Band Name

Band Website

Instrument Played

Choose one of the following memberships:

Individual: $20.00/year

Family: $30.00/year *

Names of Family Members

Senior (60+): $15.00/year

Student: $15.00/year **(Copy of ID)

Lifetime: 10XAnnual** (NA for Student)

Business / Sponsor: $100.00/year

Make Check To:

Mail Form & Check to: