P. O. Box 4064
Lynchburg, VA  24502-0064
Tele. (434) 237-8080
Website:  www.jamesriverblues.org
E-Mail:  jamrivblusoc@aol.com
MEMBERSHIP APPLICATION
The James River Blues Society is a 501(c)(3), non-profit, tax exempt, all volunteer organization dedicated to promoting and preserving blues music in the central and western areas of Virginia.  Individual, Family, or Blues Buddy membership entitles you to the following:  membership ID, e-mail alerts, discounted admission to JRBS sponsored events where applicable, and discounts from selected merchants.  Sponsor membership entitles you to membership ID, e-mail alerts, and free business card size ads on our website. 

MEMBERSHIP IN THE SOCIETY IS FOR A PERIOD OF ONE YEAR
q   NEW MEMBERSHIP		q   RENEWAL

q	Individual	[$15.00]			q	Blues Buddy  «	[$30.00]
q	Family		[$20.00]			q	Sponsorship		[$100.00] minimum

Please inquire regarding overseas rates.

« Blues Buddy membership includes one free JRBS t-shirt.è State t-shirt size:  L  XL  2X  3X

q CHECK HERE IF YOU WOULD LIKE YOUR T-SHIRT MAILED.  YOU MUST INCLUDE AN ADDITIONAL $4.00 FORSHIPPING AND HANDLING.

Please return this membership application with a check or money order made payable to the James River Blues Society.  Thank you!

PLEASE PRINT OR TYPE

NAME	

ADDRESS	

CITY                                                                          STATE                                     ZIP	

TELEPHONE   (Home)                                                                      (Work)	

E-MAIL ADDRESS (To receive JRBS e-mails)	

OCCUPATION  (Optional)	

5	Check here if you do not wish for your name and address or e-mail address to be distributed to other organizations that promote the blues.

REV. 4/2006