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SOUTHWEST BLUEGRASS ASSOCIATION DONATION FORM
SEND TO:

Southwest Bluegrass Association, PO Box 720974, Pinon Hills, CA 92372-0974

 The Southwest Bluegrass Association (SWBA) is a 501(c)(3) Non-Profit Corporation

Donations may be tax deductible

 

MAKE CHECKS PAYABLE TO SWBAA

Please Print

Date: __________________

Last Name: __________________________________ First Name: ______________________ MI:______ 

Address:_______________________________________________City:______________________

State: ____ Zip: __________ Phone#: ___________________ E-mail:_________________________

Amount of Donation $_________________  for Kid's Program____  for General Fund_____

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Optional Donation Combined with Membership (For those who would also like to take this opportunity to join the association):

Please Indicate Choice Below (Check One): 

______$20.00--1 year single, married, family/ Number of children under 18:___________

______$25.00--1 year band, business/ Number of band members:____________

______$40.00--2 year single, married, family/ Number of children under 18:___________

______$6.00---Canadian Postage; or 1st class postage per year; Double for 2 year membership. 

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$_____________TOTAL ENCLOSED  (Donation:$______ + Membership:$_____)         

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Make Check Payable to: SWBA;  ENCLOSE STAMPED ENVELOPE if also applying for membership

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OFFICE USE ONLY:     [   ] CASH   [   ] CHECK#________  AMT $ ___________

NOTE: There will be a $25.00 charge for any returned check                             By: _______