The Santa Barbara Blues Society 
      Membership Application & Renewal Form

 Membership Status: __ New       __ Renewal

 Membership Type:   __ One Year  __ Lifetime

 Name:

 Street / P.O. Box:

 City:

 State:

 Zip Code:

 Telephone:

 E-Mail Address:

 Be A Volunteer?:   __ Yes       __ No

 Best Time To Call?:

 Desired Musician(s)?:


Please Print This Page & Return With Your Remittance Of  
       Either $20 (1 Year) Or $60 (Lifetime) To: 

            The Santa Barbara Blues Society 
                     P.O. Box 30853 
                Santa Barbara, CA 93130 

       Your Membership Card Will Be Mailed To You
  (Checks Payable To The Santa Barbara Blues Society)