Bristol Jazz Society Membership Application

 Please use block letters

   Title_____ Forename_______________________Surname_________________________

   Second Member at the same address:­

   Title_____ Forename_______________________Surname_________________________

   Address for mailing, including post code and Email address (if applicable):

_______________________________________________________________________

_______________________________________________________________________

 Tel. ___________________________________Email___________________________    

If you are a musician please state what instruments you play: _______________________  

_______________________________________________________________________

 This information will be held by the Bristol Jazz Society and used for the purpose of sending newsletters and other information relating to the Society, or of possible interest to its members. It will not be released to a third party without the prior consent of the member concerned.

 Signature of Member________________________________Date_______________

 Signature of Joint Member___________________________ Date_______________

FEE ENCLOSED (please circle as applicable)        £4 single                         £6 joint

DONATION ENCLOSED: (If you would like to send a donation to help with the work of the Society, please enter the amount here.)                 £___________

Cheques / Postal orders should be made payable to 'The Bristol Jazz Society'

Please send to:-

The Membership Secretary, Bristol Jazz Society, 70, Hall Street , Bedminster, Bristol , BS3 5PP

For more information call Jean on 0117 9668581