NAME:_____________________________________________________________________

ADDRESS:___________________________________________________________________

CITY - STATE: _____________________________________ ZIP + 4 ___________-___

PHONE: (______)___________________ E-MAIL: ________________________________

Do you play a bluegrass instrument ? Please circle

Banjo Bass Dobro Fiddle Guitar Mandolin Other __________________________

The Seven Mountains Bluegrass Association needs your help to promote bluegrass music !!

APPLICANT'S SIGNATURE: _______________________________ DATE: __________

Please remit your annual dues, payable to Seven Mountains Bluegrass Association ($10.00), and mail with this application to Jean Snyder at the address below.

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Association Use Only:

Membership No.         Expiration Date:

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Membership in the Seven Mountains Bluegrass Association is on a calendar year basis. If you become a member after September 1st, your membership will expire one (1) year from the following January.

Received of ________________________________________ on ___________for year ending ____________ten dollars ($10.00) for annual dues to the Seven Mountains Bluegrass Association, a nonprofit organization.

Please notify the secretary of any change of address.

The SEVEN MOUNTAINS BLUEGRASS ASSOCIATION meets the third (3rd) Sunday of every month, from 2:00 to 5:00 p.m., at the First United Methodist Church, Fellowship Hall, 135 West Simpson Street, Mechanicsburg, PA

JEAN M. SNYDER, 827 NEW VALLEY ROAD, MARYSVILLE, PA 17053-9716