Cowboy Poets of Utah

Membership Application Form

 

 

 

 

Name:

Address:

City:

State:

Zip:

Phone:

E-Mail Address:

It's OK to list my information in the membership directory:   

Name:  ___Yes ___ No Address: ___ Yes ___ No Phone #(s): ___Yes ___No E-Mail:___Yes   ___ No

 

(Please check all that apply)

 

Poet

Musician

Single Act

Duo/Group

Fan (non-performing member

 

Name of Group:

 

Tell us about yourself (use the back if more room is needed!):

 

 

 

 

 

 

 

 

 

Single Membership___($20)     Youth (under 18) ___($5)   Couple/family membership____($30)

(Renewal Memberships are due March 1st – Single $15; Couple $25)

Please print your name(s) exactly as you want it to appear on your name tag:

 

________________________________________ /__________________________________________

 

Please make your check payable to Cowboy Poets of Utah and mail to:

Gordon Thomas    425 West Center   Genola, UT   84655