If you would like to join our association, please print out this page,
Fill out the form and submit it along 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

APPLICATION FOR MEMBERSHIP

Middle Georgia Bluegrass Association

A non-profit and family- oriented organization promoting bluegrass music in central Georgia

 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

 2012 Dues paid : ­­­­­­­­_______________________________

 2013 Dues paid : ­­­­­­­­_______________________________

 2014 Dues paid : ­­­­­­­­_______________________________

 2015 Dues paid : ­­­­­­­­_______________________________

 2016 Dues paid : ­­­­­­­­_______________________________

 2017 Dues paid : ­­­­­­­­_______________________________

Keep on Pickin’