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Your Name..............:

Your Email Address..:

Your Mailing Address:

City: State: Zip Code:

Your Phone No..:

Would you like to be on our e-mail list ?
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Would you like to join our band?
yes
no

What instrument do you play?
Keyboard
Percussion
Trumpet
Trombone
Sax
Guitar
Bass
Vocal

Would you like us to contact you?
yes
no

Comments............:

Please the Information