Hot Jazz and Alligator Gumbo Society, Inc.

Membership Application

Calendar Year - 2018


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

Application for:   NEW (   )   RENEWAL (   )   COMBINATION (   )

Name of First Member:    _______________________________________

Name of Second Member:_______________________________________

Phone Number:______________   Email Address:____________________

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

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

New Members: How did you hear about HAGS?____________________________________________

Musicians Only


 Day Gig & Phone number if interested in calls:___________________________________________________

Comments:________________________________________________________________________________________                      __________________________________________________________________________________________________

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


c/o Starace

6065 Verde Trail S.,

G Bldg, Apt. 116,

Boca Raton, Fl. 33433

Your membership card(s) will be mailed shortly after your application is received.

If you have any questions, please call -  Glyn Dryhurst - (954)-651-0970