Internet Membership Form

Print this form, fill it out and mail with payment to:

The Inland Empire Blues Society

P.O. Box 11513

Spokane, WA. 99211-1513

One Year (12 issues): Individual $20.00; Family (two with same residence) $35.00; International: $22 (U.S. Funds only); Business $75.00

Name:________________________________________________________

Mailing Address:_______________________________________________

City:____________________State:________Zip + 4:__________________

Telephone:____________________________________________________

E-Mail:_______________________________________________________

The Inland Empire Blues Society will not give, sell, or otherwise relinquish its mailing list.

Would you like to receive other local blues information or mail from the Inland Empire Blues Society?

YES_____ NO_____