Please Check the Level of Membership You have Chosen
___ Blues Fan $25
___ Blues Patron $100 
___ Blues Supporter $250
___Blues Sponsor $500
___Blues VIP $1000
___Lifetime Membership $5000

 

Make check or money order payable to:
MS Delta Blues Society of Belzoni, Inc
Your membership fee must accompany your application. Mail to:
MS Delta Blues Society of Belzoni, Inc
PO Box 691
Belzoni, MS 39038

Please allow 4 to 6 weeks to receive your membership package.

 

For chapter use only:
___________________________________________________________________________________
Date received_____________________ Check Number____________________
Amount__________________________ Membership Number_______________