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Please print this form out on your printer and mail it to the Secretary/Band Distributor.

Club Patch
Patches are $5.00 each.
Can be purchased and picked up at the shows.
Or email Mark Newby to buy and have shipped with a shipping fee.
____ = Total Patches




Club Hat
Hats are $10.00 each.
Can be purchased and picked up at the shows.
Or email Mark Newby to buy and have shipped with a shipping fee.
____ = Total Patches




*Don't forget to pay your yearly dues!

Name ______________________________________________________________

Address _____________________________________________________________

City ____________________________________State________ Zip_____________

Phone _____________________________E-mail ____________________________

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