Central Mississippi Blues Society
Membership Application

Fill out this form, print it, and send with a check to:
P.O. Box 8314 - Jackson, Mississippi 39284

Make Checks payable to: The Central Mississippi Blues Society
fee scale is located at the bottom of application

Name:

Business Name, if applicable:

Address:

City:

State:

Zip:

Email Address:

Telephone:

Fax:

Membership Level:

Musician-$25 College Student-$15 Individual-$40 Family-$75 Business-$100

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