Regina Delta Blues Association

	FOR OFFICE USE ONLY

	Date of Application____________________

	Membership #________________________

Thank you for your renewal / updated information.

Your membership helps promote our annual mid-winter blues festival,

as well as concerts that we are able to provide throughout the year for your blues entertainment.

MEMBER RENEWAL / UPDATE FORM

Name: ___________________________________________________________________

Address: _________________________________________________________________

City: ___________________ Province:

Postal Code: _____________ Home Phone:

Other Phone Number if Desired: ____________________

E-Mail: (to receive the Delta Blues newsletter)___________________________________

Type of Membership:

Single: _____ $10.00

Family: _____ $20.00

If Family Membership, names of family members:
1)    __________________________________________
2)    __________________________________________
3)    __________________________________________
4)    __________________________________________

Are you interested in volunteering for the mid-winter Blues Festival? (end of Feb)

Yes Not at this time No __

Please make cheque or money order payable to: Regina Delta Blues Association

and mail to:

Regina Delta Blues Association

47 Greenwood Crescent

Regina, SK

S4X 1G5

MEMBER RENEWAL / UPDATE FORM

Name: ___________________________________________________________________

Address: _________________________________________________________________

City: _______________________________________ Province: ____________________

Postal Code: _______________________________ Home Phone: __________________

Other Phone Number if Desired: ____________________

E-Mail: (to receive the Delta Blues newsletter)___________________________________

Type of Membership:

Single: _____ $10.00

Family: _____ $20.00

If Family Membership, names of family members: 1) __________________________________________ 2) __________________________________________ 3) __________________________________________ 4) __________________________________________

Are you interested in volunteering for the mid-winter Blues Festival? (end of Feb)

Yes ______ Not at this time ______ No ______

Please make cheque or money order payable to: Regina Delta Blues Association

City: ___________________ Province:

Postal Code: _____________ Home Phone:

If Family Membership, names of family members:
1)
2)
3)
4)

Yes Not at this time No __