First Name:
Last Name:
Email:
Street:
City:
State:
Zip:
Phone:
Cell:
Web Page:
Are you interested in helping out at Blues Society events or with Blues Society Commitees?	Undecided Yes No
Do you play blues?	I just play the Stereo. Yes No
Instrument:
Are you in a band?:	Yes No
Band Name:
Band Website:
May we ask your date of birth?
Your Profession?:
How would you like to receive the news letter?:	Email Mail
Do you have any skills you feel would benefit the BSWPA?	Type Skills here

If you would like to mail your form, download and fill out this document and
send it with your $20.00 check or money order to:

BSWPA Membership
P.O. Box 97978
Pittsburgh, PA 15227