Columbus Blues Alliance Membership Form
NAME
ADDRESS
CITY				STATE					ZIP
PHONE				CAN YOU VOLUNTEER?
EMAIL
MEMBERSHIP TYPE		$19 Member + Paper				$33 Member, Paper + Choice of: Shirt, Hat, CD, or Book (circle one) Price includes $3 for shipping and handling
SHIRT TYPE & COLOR:
SHIRT SIZE	S		M		L		XL	XXL		3XL
SUGGESTIONS:

NOTE: The CBA will charge $15 for any checks returned for insufficient funds

MAIL TO: Columbus Blues Alliance 1350 West Fifth Avenue, Suite 10-D Columbus 43212