KENTUCKY FRIENDS OF BLUEGRASS MUSIC CLUB, INC.
303-A BLUEGRASS LANE, CLAY CITY, KY. 40312-9588
PHONE: 606-663-9008 email: kyfriends.usAPPLICATION FOR MEMBERSHIP
MEMBERSHIP FEES PER YEAR: SINGLE $12.00; COUPLES $18.00;
STUDENTS $(15 TO 18) $5.00; BANDS $25.00
| NAME:_______________________________________________
BIRTHDAY MONTH:_________________ ADDRESS:____________________________________________ FOR COUPLES ONLY:________________ CITY, STATE:_________________________________________ SPOUSE NAME:______________________ ZIP CODE:____________________________________________ SPOUSE BIRTHDAY MONTH__________ TELEPHONE:_________________________________________ ANNIVERSARY MONTH:_____________ EMAIL:_______________________________________________ MEMBERSHIP TYPE:
PAID BY:
MEMBERSHIP INFO:
DATE:_____________ RECEIVED BY:________________________ AMOUNT:$____________CARD:____________COMPUTER_____________ |