MEMBERSHIP APPLICATION
AND/OR RENEWAL FORM Date________
First Name_____________________
Last Name_____________________
Address_______________________
City__________ State___ Zip______
Phone (__)_______ Cell (___)______
Email__________________________
Web Page_______________________
Would you like to help at BSWPA events or Committees? Yes / No
Do you have any skills you feel would
benefit the BSWPA?______________
Do you play Blues? Yes / No
What instrument? _________________
Are you in a Band? Yes / No
Band Name______________________
Your profession? _________________
How would you like to receive the
Newsletter? Mail / Email
Yearly memberships dues are $20. Please submit your dues with this application in person, by mail, or online
BLUES SOCIETY
P. O. BOX 97978
PITTSBURGH, PA 15227
724-378-8926
bswpa.org
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