Washington Bluegrass Association
New Membership and Member Renewal Form
Member Name:__________________________________________________
Address: ______________________________________________________
City: __________________________________ State: ____________________ Zipcode: ____________
Phone: ( ) - _______________________ Email: ___________________________________________
Membership Category:
New Membership
Renewal
Single
Family (2 or more in family)
The One-year Membership rate for 2009 is $20/US or Canada.
This is a Gift Membership: From:
(Name:) __________________________(City:)_________________________
New Member: 1-year American membership ($20)
New Member: 3-year American membership ($45.00)
New Member: 1-year Canadian membership ($20)
New Member:3-year Canadian membership ($45)
Renew: 1-year American membership ($20)
Renew: 3-year American membership ($45)
Renew: 1-year Canadian membership ($20)
Renew: 3-year Canadian membership ($45)
I'm in a band named: __________________________________________________________________
(All Payments must be made with U.S. Funds)
I play these instruments:__________________________________________________________________
(It is not neccesary to play an instrument or be in a band to be a member of the Washington Bluegrass Association.)
I'm willing to be a volunteer helper for:
Festivals
Publicity
Newsletter
Other:_________________________________________________
Complete and mail this form, with payment by check or money order (U.S. Funds) to:
Washington Bluegrass Association
Attn: Membership Application
PO Box 490
Toledo, WA 98591