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SEBA Online Membership Form

06-24-2017 21:29:02 = Current Time
06-24-2017 13:40:51 = Latest Application

NOTES:
  • The information you enter on this form is not sent to PayPal. You must initiate your PayPal payment separately.
  • If your address has changed or for some other reason you are not receiving your newsletter, or to check on the status of your membership, please contact our database manager Membership
  • Payment Page

Visit our SEBA Member Pages where some of today's best bluegrass bands, businesses, and people post their information and/or services.

* Denotes REQUIRED FIELDS

Your Contact Information:

* First Name

* Last Name

* Phone Number i.e. 123-456-7890

Your primary eMail Address

PayPal User Name (if you have one)

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Membership Type:

* Membership Type

E-Membership - $20.00

Regular Membership - $25.00

Family Membership - $30.00

Professional Membership - Band - $40.00

Professional Membership - Promoter - $40.00

Professional Membership - Business - $40.00

Professional Membership - Music Instructor - $40.00

Professional Membership - Individual - $40.00

E Pro - $30.00

New Membership or Renewal?

New

Renewal

Other:

Would you like to be added to the Membership Directory? Yes No

Would you like to be added to the Email list? Yes No
You will receive the FREE eFans Bluegrass Happenings Newsletter. (You may opt out at any time.)

Name of your SEBA Web Page (if applicable)
(Examples: "My Band"; "My Business or Company"; "My Page")
What instruments do you play?
Additional information
Please list additional e-mail addresses for your Band or Family members (limit 6).


After clicking SUBMIT, your membership information will be sent to to SEBA, and you will be taken to another form.