MEMBERSHIP
APPLICATION
MEMBERSHIP EXPIRES __________
The CENTRAL
ILLINOIS JAZZ SOCIETY is a non-profit organization open to anyone who enjoys
jazz. You do NOT have to be a musician to be a member.
The society's aim is to further the appreciation and quality of jazz in
Central Illinois. We do this by providing opportunities for jazz artists to play
and jazz lovers to enjoy their favorite music.
Members are entitled to
reduced admission at the monthly concerts. All income from memberships and concerts goes
entirely to support the performances. None of our officers or committee members
are paid. Enjoy
yourself_ Become a member of the CENTRAL
ILLINOIS JAZZ SOCIETY and support JAZZ
in Central Illinois.
----------------------------------------------------------------------------------------------------------------------------------------------------
NAME
____________________________
TYPE:
NEW __________
RENEWAL __________
ADDRESS
_________________________
DATE
_________________
CITY
_____________________________
PHONE
_________________________ (Home)
PHONE _________________________ (Work)
STATE ____________ ZIP ___________ CELL PHONE _________________________
__________$25.00 SINGLE
(Individual Membership)
__________$45.00
FAMILY
(Immediate family living at
above address)
No. of cards
__________
__________$60.00 ASSOCIATE
(Business, organizations, or individuals receive special
mention
and ad rates in our publicity)
No.
of cards __________
__________$10.00
NEWSLETTER ONLY
ARE
YOU EMPLOYED BY A COMPANY THAT OFFERS A "MATCHING-FUNDS" program?
YES
_____ NO
_____ DON'T KNOW _____
EMPLOYER ____________________
IF
YES, PLEASE FILL OUT THE APPROPRIATE FORM AND SUBMIT IT TO YOUR COMPANY:
THIS CAN BE OF GREAT FINANCIAL ASSISTANCE TO CIJS!
Please send the lower half of this form to:
CENTRAL ILLINOIS JAZZ SOCIETY
% Ray Ellington
1227 W. Barker, Peoria, IL. 61606
If you have any questions or need information contact:
Peoria- DICK MARSHO
------------692-5330
Peoria- LEN LLOYD-----------------243-2110 Peoria-- ROBERT CANNON ---------243-1582
Peoria --MAUREEN O' HAENNY--691-4516 Peoria --RAY ELLINGTON------------472-5881
Peoria --JAKE JACOBSEN ---------685-6307 Dunlap --BILL DUNCAN --------------253-8532