Membership Application

First Name

Last Name

Address

Home Phone

Cell Phone

Email

How involved would you like to be in the Blues Society? (Passive 1, 2, 3, 4, 5 Active)

DO YOU HAVE ANY SPECIAL SKILLS? (Musician, Artist, Writing, Technology, Public Relations, Sales, etc.)

WHAT WOULD YOU LIKE TO SEE THE BLUES SOCIETY ACHIEVE?

HOW DID YOU HEAR ABOUT MVBS?

PO Box 207 New Hartford, NY 13413
The Mohawk Valley Blues Society is a 501 (c) (3) nonprofit organization.

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