Tell Us About Yourself (whatever you're comfortable with) Your Name Your Occupation Your Work Phone Your Email Address Your Birthday Instruments You Play Bands You Belong To Tell Us About Your Partner or 'Co-Member' (whatever you're comfortable with) Your Partner's name Your Partner's Occupation Your Partner's Work Phone Your Partner's Email Address Your Partner's Birthday Instruments Your Partner Plays Bands Your Partner Belongs To Mailing & Contact Information Mailing Address City, State Zip Home Phone Fax Membership Information Single: $30 / year Two Adults $40/ year Students / Senior (over 65) $25 / year Family : $40 / year List Other Family Members: ** Discounted Memberships only receive electronic delivery of periodic printed material ** Single Discounted: $25 / year Two AdultsDiscounted: $35/ year Students / Senior (over 65) Discounted: $20 / year Family Discounted: $35/year: List Family Members: Referred By Yes, I'd like to receive mailings about Blues Events Yes, you can contact me by telephone Volunteer Interests: (check all that apply) Activities Committee Blues in the Schools Committee Archives Festivals Internet / Web Page Mailings Newsletter Publicity Concession Sales Whatever's Needed Other Comments:
Single: $30 / year Two Adults $40/ year Students / Senior (over 65) $25 / year Family : $40 / year List Other Family Members:
** Discounted Memberships only receive electronic delivery of periodic printed material **
Single Discounted: $25 / year Two AdultsDiscounted: $35/ year Students / Senior (over 65) Discounted: $20 / year Family Discounted: $35/year: List Family Members:
Atlanta Blues Society Box 352 931 Monroe Drive Ste. 102 Atlanta, GA 30308 404.237.9595 absmail@mindspring.com
