Membership Application

1

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New Application

Renewal

Basic: Individual ($40/year)

Basic: Family/Couple ($60/year)

Platinum Sustaining ($15/month)

Gold Sustaining ($10/month)

Basic: Student ($5/year)

Silver Sustaining ($5/month)

Corresponding ($20 per year - outside 100 mile radius)

First name

Cell Phone

Last name

Home or Work Phone

Company

Street Address

City

Postal / Zip code

Street Address Line 2

Region/State/Province

Country

Preferred method of contact

Phone

Text

For Family Membership Only - Please add name and contact of second adult family member.

First name

Last name

Preferred Phone Number

Briefly describe your Jazz interests

Are you a musician?

If so, what instrument?

How did you hear about Jazz Pensacola?

Name of Jazz Pensacola member that referred you

Would you like to volunteer?

Current/past occupation or any special skills

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