Name______________________________________________
 
Address________________City________State________________
Zip____________
 
Telehone_____________Evening:________Cell:______________
 
Supporting Member:_________Performing member__________
 
Instruments:________________Vocalist:____________________
 
Bamd :eader"______________Name of Band:_______________
 
No. in Band:__________
 
Date of Birth:  You"_____________Your Spouse:_____________
 
Other Interest:_________________Volunteer Work____________
 
Fee Paid:  Single:($15)  Couple:  ($20)______________
Date: ___________
 
email:______________
 
Board Approval:________________
 
 
Send Application to:  WSMSS P.O. Box 644 Shattuck, OK. 73858
 
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