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Friends of the Northwinds Symphonic Band
MEMBERSHIP APPLICATION

To join the Friends of the Northwinds Symphonic Band, simply complete this form and enclose your check or money order. Make checks payable to "Northwinds Symphonic Band". Your name will appear in concert programs for one year and you will receive an invitation to attend future concerts.You may leave your contribution at the information table tonight, or mail this form and a check to:

Ron Clark
7129 N. Highland Ct.
Gladstone, MO 64118

Gold Baton

$1,000

Patron

$150

Silver Baton

$500

Contributor

$100

Encore Circle

$250

Active

$50

Amount Contributed:____________    Check:   Cash:

Name:________________________________________________

Address:______________________________________________

City: ___________________

State:_________ Zip Code:________

Email Address: ________________________________________

(Contributions to Northwinds are tax deductible to the extend of IRS Code)

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