MOHAWK
VALLEY BLUES SOCIETY
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Membership Application
First Name
Last Name
Address
Home Phone
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How involved would you like to be in the Blues Society? (Passive 1, 2, 3, 4, 5 Active)
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2
3
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5
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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?
LIFETIME MEMBERSHIP: $30
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