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QUICK JUMPS

SEBA Online Membership Form

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.

Visit our Member Organization Pages where some of the best bluegrass bands in the region post contact information as do business and promoters who offer services to bluegrass enthusiasts.

* Denotes REQUIRED FIELDS

* First Name

* Last Name

* Phone Number i.e. 123-456-7890

* Membership Type

Individual - $15

Band - $24

Promoter - $24

Business - $24

Silver Anniversary - $25

New Membership or Renewal?

New

Renewal

Band or Business name (if applicable)

PayPal User Name (if you have one)

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Would you like to be added to the Membership Directory?

Yes

Would you like to be added to the Email list?

Yes

What instruments do you play?

Other information
(If you are applying for Silver Anniversary Membership, please provide information to be included in the Silver Anniversary Program.)

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

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