Northern Illinois Bluegrass Association
Membership Application / Renewal Form

To join, please fill out the information below and mail, along with your $15 check payable to NIBA, to:

NIBA
PO Box 310
West Dundee, IL 60118


please print

First Name:_______________________________________ 

Phone:__(_____) ____________________________
Last
Name:_______________________________________
Email (optional):

____________________________________________
Address:_____________________________________  q send newsletter via email
(
not recommended for dialups)
City:_________________________________________ q please publish my information in the members-only directory
State:____________  Zip:_______________________   

 

County:______________________________________ I heard about NIBA from:

____________________________________________

Instruments you play:  

o none
o
vocals
o
guitar 

o banjo
o
mando
o
fiddle

o bass
o
dobro
o
harmonica

o dulcimer
o
autoharp
o
sound


q new           q renewal payment:___________________ month:____________

Please send check and completed application to:

NIBA  *  PO Box 310  * West Dundee, IL 60118

Thank you for your support!

www.nibaweb.org