Memberships:
Standard - $15.00
Family - $25.00 (maximum
two adults and two children under 19)
Student - $10.00 (provide student ID
number)
Senior - $10.00
Senior Family - $15.00
Patron -
$50-$100 Silver Please inquire as to
$100-$250 Gold privileges of being a
$250 + Platinum
Patron Member.
*membership fees
include any and all applicable taxes.
♪ One year membership
with card ♪ Exclusive access to special Society events
♪ Voting rights ♪ Discounts on Society merchandise
♪ Annual Members
Conference (Party) ♪ Newsletter
♪ Discount to Society events
Name(s)________________________________________ Starting Date____________________
Address_______________________________________________________________________
City____________________________________ Postal/Zip Code_________________________
Birthday(s) Month/Day__________________________________________________________
Phone (daytime)_____________________________(evenings)___________________________
E-mail Address_______________________________@________________________________
Membership Type__________________________ Amount Enclosed $____________________
New Membership Yes / No Renewal Membership #______________________________
Would you like to be a Society volunteer? Yes / No
What interest or
skills would you like to offer? _____________________________________
What I Like: (check or circle preferences) Blues__/Jazz__/Gospel__/Soul___/Latin__/Country__/Swing__/Pop__/Rock__/Other________
How Far Would You Drive To Go To A Good Blues or Jazz Event?
1 mile__/5 miles__/10 miles__/50 miles__/100 miles or more__
Please mail this form with cheque or money order to:
26-200 Fitch Street, Suite 107, Welland, ON L3C 4V9
(Allow 2 to 4 weeks for membership processing)