2008 - BUCKEYE STATE HARMONICA CLUB - 2008

Membership Application

NOTE:

Memberships run for 1 calendar year. - Expiration date is December 31st.

Please send in your dues January 1, 2008 or ASAP thereafter.

Check One of the following rates below…

[ ] REGULAR MEMBER (USA.)……………. $15.00/year.

[ ] REGULAR MEMBER (CANADA)….…… $18.00/year.

{Other countries please inquire}

[ ] LIFETIME MEMBERSHIP ………….…… $150.00.

Check all that apply: Renewal, New, and/or Address Change…

[ ] Renewal, [ ] New (first time member), [ ] New Address

Please make check payable in U.S. funds to…

Buckeye State Harmonica Club, Inc.

and send to: Jack Ely, Membership Chairman

1991 West Third Avenue

Columbus, Ohio 43212-2704

(614) 607-5222

Please complete name and address and send to address above.

NAME: __________________________________________________

ADDRESS: ________________________________________________

CITY: ________________________STATE: ____ ZIP: _____________

PHONE: (________) ____________ - __________________________

Your e-mail ____________________________ Web site____________________________

Birthday Club: ____ - ____ - ____ (Enroll me - year will not be printed)

mo day year (optional)

Thank you for supporting BSHC 02/08