YES! Sign Me Up For The Blues
| Name | ____________________________________ |
| Address | ____________________________________ |
| City | ____________________________________ |
| State | ____________________________________ |
| Zip | ____________________________________ |
| Phone (Home) | ____________________________________ |
| Phone (Work) | ____________________________________ |
| ____________________________________ | |
| Occupation | ____________________________________ |
| Do you play an Instrument? (If so what?) |
____________________________________ |
| Can you help us out? | ____________________________________ |
$20/year Single Blues' Lover
$30/year Family with da Blues
Mail to: Suncoast Blues Society, PO Box 4232, Tampa, FL 33677