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APPLICATION FOR MEMBERSHIP
Middle Georgia Bluegrass Association
A
non-profit and family- oriented
organization promoting bluegrass music
in central Georgi
Name:
_____________________________________
Date:____________________
Telephone:_______________________
PLEASE PRINT
Street Address:
______________________________________________________________________________________
City: ___________________________________
State:______________ Zip:
_________________________
E-Mail: ____________________________________________
Please list any instruments that you
play or special interests:
________________________________________
__________________________________________________________________________________________
Please submit this application with $15
annual membership fee to:
Middle Georgia Bluegrass Association ,
C/O Ebin Shepard , 148 Island View,
Lizella, GA 31052 , 478-935-3952 ,
ebinshepard@cox.net
2007 Dues paid :
_______________________________
2008 Dues paid :
_______________________________
2009 Dues paid :
_______________________________
2010
Dues paid :
_______________________________
2011 Dues paid :
_______________________________
2012 Dues paid :
_______________________________
Keep on Pickin’
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