Membership Form

South Shore Folk Music Club
P.O. Box 156
Kingston, MA 02364-9998
781-871-1052
www.ssfmc.org (a non-profit organization)

New Member/Friend ____ Renewal ____

Name _____________________________________

Date ___________

Address _________________________________

City _______________State _____ Zip ___________

E-mail ___________________

** I wish to receive the Hurdy Gurdy via E-mail regular mail
* I'm not ready to become a member but wish to receive the Hurdy Gurdy via regular mail
*e-Friends receive the Hurdy Gurdy via E-mail .

Membership Term: September 1 through August 31.

2003/2004 Membership Changes: Membership Changes

Please mail this application via regular mail to the address above with self-addressed, stamped envelope.

SSFMC USE ONLY

CARD NUMBER ____________________
EXPIRATION DATE ________