Membership Application

Hot Jazz and Alligator Gumbo Society, Inc.

Calendar Year - 2015

Regular Membership Dues:  Patron Membership Dues:  Sponsorships:
Individual - $30 Individual - $120 Benefactor Sponsorship - $400
  Couples  -  $45  Couples  -   $200 Featured Band Sponsor -  $600

Application for:   NEW (   )   RENEWAL (   )   COMBINATION (   )

Name of First Member:    _______________________________________

Name of Second Member:_______________________________________

Phone Number:______________   Email Address:____________________

Address: Street,P.O.Box,Rural Route etc.__________________________________ Apt.#_____

City, Town, Village:__________________________ State:__________  Zip Code:___________

New Members: How did you hear about HAGS?____________________________________________

Musicians Only


 Day Gig & Phone number if interested in calls:___________________________________________________

Comments:________________________________________________________________________________________                      __________________________________________________________________________________________________

Check form for accuracy, Print, enclose your check along with the application and mail to:


3654 NE 19th Ave.

Fort Lauderdale, FL. 33308

Your membership card(s) will be mailed shortly after your application is received.

If you have any questions, please call Marcie Reid at 954-563-5390.