Supporter of the Endless Mountains Blues Fest™

Support our charity endeavor and receive a pass to the upcoming fest
we must receive your support by April 1st to qualify for a free concert pass
We will have your name at the gate for your concert admission

money orders Payable to:
Scranton/Wilkes Barre Blues Association
Please Mail To: 
The Endless Mountains Blues Fest
RR2 Box 355, Dalton, Pa. 18414
Please circle one
$15.00 Individual          $50.00 Corporate/Business

Date:__________________

Name or Business Name:____________________________________________________

Address:____________________________        City, State, Zip____________________

Email:(for confirmation)________________________________________

Phone: __(    )_____________________

If you are able to volunteer or donate legwork, sell tickets (free pass for high sales), merchandise, give-aways, or grounds services to a  blues fest, please specify here:

_______________________________________________________________________

Please sign here _______________________________