Hot Jazz and Alligator Gumbo Society, Inc.

Membership Application

Season Sept - June, 2019-2020

 

Regular Membership Dues:  Patron Membership Dues:  Sponsorships:
Individual - $40 Individual - $120 Benefactor Sponsorship - $400
  Couples  -  $55  Couples  -   $200 Featured Band Sponsor -  $600

(A couple is two adults / friends sharing one address)

Application for:   NEW (   )   RENEWAL (   )   COMBINATION - New & Renewal (   )

Name of First Member:    _______________________________________

Name of Second Member:_______________________________________

Phone Number:______________   Email Address:____________________

 

        Please complete below, even if address is the same.

Address: Street,P.O.Box,Rural Route etc.__________________________________ Apt.#_____

City, Town, Village:__________________________ State:__________  Zip Code:___________

New Members: I heard about HAGS through:____________________________________________

** Your membership cards will be mailed shortly after your application is received, if you have any questions, please call Carlene Starace 561-809-6409. No Refunds.

 

Musicians Only Instruments:_____________________________________________________________  

 

Comments/Feedback:________________________________________________________________________________________        

  __________________________________________________________________________________________________________

 

Check form for accuracy, Print, enclose your check along with the application and mail to:

H.A.G.S. c/o Starace 6065 Verde Trail S. Apt. G116

Boca Raton, Fl. 33433