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 _and at special programs sponsored by
the CENTRAL, ILLINOIS JAZZ SOCIETY. DISCOUNTS are available at DON'S MUSICLAND
and DOWN BEAT MAGAZINE. 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.
--------------------------------------------------------------------------------------------------------------
APPLICATION
NAME
________________________________
TYPE:
NEW _______
RENEWAL _______
ADDRESS
_______________________________________
DATE
_________________
CITY
_____________________________
PHONE
_________________________ (Home)
STATE
____________ ZIP
___________ PHONE _________________________ (Work)
E-MAIL
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 this form and check to: CENTRAL ILLINOIS JAZZ SOCIETY
441
E. High Point Dr, Peoria, IL.
61614
If you have any questions or need information contact:
Peoria-
MARY SALVETTI------ 693-7305 Peoria- DICK MARSHO
---------692-5330
Peoria-
TOM HOWARD---------688-5877
Galesburg- BOB DANFORTH ---343-2220