Northern Kentucky Bluegrass Music

Association                              

Membership Application

Membership Fees per Year:  Single  $12.00  Couple $15.00  Band  $25.00

 

 

Name_____________________________

 

Address___________________________________ 

 

City State_________________________________ 

 

Zip Code_____________ 

 

Telephone_________________________ 

 

Birthday Month______________ 

 

Spouse Name_______________________ 

 

Spouse Birthday Month_______________________ 

 

Anniversary Month__________________________ 

 

Membership Type:  Single__________  Couple___________  Band________ 

 

Paid By:  Cash______   Check_______ 

 

Special Talents:  Musican________  Computer________  Other________ 

 

Date___________________

 

Email ___________________

 

 

 

 

Please return to:

NKBMA
PO Box 133
Hebron Ky. 41048