EUSPBA Membership Form

Mail this form with a check for $25, payable to The EUSPBA, to:
EUSPBA, Suite 560, People's Plaza - 316, Newark, DE, 19702

Membership Type
    ___ New
    ___ Renewal

Name:    _____________________________________________________________

Address: _____________________________________________________________

City, State, Zip: ____________________________________________________

Country: _____________________________________________________________

Phone:   _____________________________________________________________

___ Check here if you do not want your name or address disclosed.

Branch Affiliation

    ___ Metro            ___ Northeast     ___ Unaffiliated
    ___ Mid-Atlantic     ___ Southern

Solo Competing Classification: (Check all that apply.)

    ___ Non-Competitor

  Piping
    ___ Judge         ___ Amateur III
    ___ Open          ___ Amateur IV, Senior (age 18 & over)
    ___ Amateur I     ___ Amateur IV, Junior (age 17 & under) Birth date: __________
    ___ Amateur II    ___ Amateur V (practice chanter)

  Snare
    ___ Judge         ___ Amateur II
    ___ Open          ___ Amateur III
    ___ Amateur I     ___ Amateur IV

  Bass/Tenor
    ___ Judge         ___ Open Tenor
    ___ Open Bass     ___ Amateur Tenor I
    ___ Amateur Bass  ___ Amateur Tenor II

  Drum Major
    ___ Judge         ___ Open         ___ Amateur

For EUSPBA Use:

Date: __________________ Check No.: ________________ EUSPBA No.:  __________________