Minnesota Blues Society Membership Form

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YES, I WANT TO BE A MEMBER OF THE MINNESOTA BLUES SOCIETY

Name ____________________________________

Address ____________________________________

City ____________________ State__________ Zip __________

Telephone ____________________________________

E-mail ____________________________________

Website address (URL) ___________________________________

____ I am a musician. Please add my link to the "Resources" page.

Please indicate level of Membership you desire:

____ Individual Membership @ $18/year

____ Individual Membership (3-Year) @ $50

____ Two Memberships from Same Family/Household @ $30/year

____ Two Memberships from Same Family/Household (3-Year) @ $85

____ Lifetime Membership @ $200

____ Gold Sponsor Membership — listing, link and logo — $150/year

____ Silver Sponsor Membership — listing and link — $100/year

____ Regular Sponsor Membership — listing — $50/year

____ National Sponsor Membership (Non-local) — listing, link and logo — $350/year

YES, I WANT TO PARTICIPATE IN THE "ADOPT A MUSICIAN" HISTORICAL DOCUMENTATION PROGRAM.
(fill in the name of musician, individual, entity, nightclub, etc. below)

First Choice ________________________________

Second Choice ________________________________

Third Choice _________________________________

Minnesota Blues Society is a 501(c)(3) non-profit organization. Membership contributions and donations are tax-deductible.

Please make your check payable to Minnesota Blues Society and mail it with this form to:

Minnesota Blues Society
P.O. BOX 580704
MINNEAPOLIS, MN 55458

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