DETROIT BLUES SOCIETY

MEMBERSHIP APPLICATION

Print the application, complete the appropriate entries and mail it to the address shown below.

Name__________________________________________________

Address________________________________________________

City__________________________State_____Zip Code__________

Phone___________________________________________________

E-mail___________________________________________________

New_____ Renewal_____ Additional Donation____________________

Student____ $10 Current I.D. Required (1 Year)

Basic_____ $25 worldwide (1 Year)

Gift Membership_____ $25 worldwide (1 Year)

Family_____ $35 worldwide (1year)

Corporate____ $199 worldwide (1 Year) Includes listing in the Blues Notes and a banner onthe DBS web site

Check here if you are interested in volunteering_____

Send check or money order to - Detroit Blues Society, P.O. Box 488, Goodrich, MI 48438