Sponsor/Corporate Name ____________________________________________________________
Address ____________________________________________________________________________
City ___________________________________ State _____________________ Zip ______________
Telephone_________________________________ Fax ____________________________________

Please Check One:
          Package                                                   Cost
 Pinetop Perkins Package……………..……….$1000.00
 Boogie Woogie Package…………………….....$800.00
 Down Home Blues Package………………..…..$700.00
 Delta Blues Package……………………….…….$500.00
 Mississippi River Package……………..………..$350.00
 Rhythms & Blues Package…….……………..…$250.00
 Soul Blues Package……………………………...$150.00

Enclosed is my check for $__________________

I’m proud to be a sponsor of the 1st Annual Pinetop Perkins Blues Festival.

Sponsor/Authorized Signature: ______________________________________Date_____________

Sold By: ___________________________________________________________________________