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

Date: _______________ 

Name(s): ______________________________________________________________

           ______________________________________________________________

Address: ______________________________________________________________

City, State  Zip: ________________________________________________________

Phone (optional): _________________________________________________________

Email(s): _______________________________________________________________

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: 18 Aug 2008