Fax The Mississippi Delta Blues Society

Name	____________________________________

Address	____________________________________
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Phone #	____________________________________

Fax #	____________________________________

Level of Membership/Sponsorship	_____________

Amount Enclosed	_____________________________

Would you like to volunteer?	_____________________

Volunteer Interest	_____________________________

Birthdate	_____________________________________


Which blues act(s) would you like to see performing at MDBS 
festivals and Functions?
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Comments
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