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Membership Level
*
$50
-
Friend
$100
-
Contributor
$250
-
Supporter
$500
-
Director
$
Sponsor Level
$1,000 - Bandleader
$2,500 - Stakeholder
$5,000 - Composer
$10,000 - Jazz Master
Your Name
*
Prefix
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Last Name
Suffix
Email
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Phone
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Address
*
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Are you a musician?
Yes
Primary Instrument
What is your primary instrument?
Is this on behalf of, or in memory of, someone else?
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select one
in honor of
in memory of
Tribute Name
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First Name
Last Name
Please notify:
First Name
Last Name
Email
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Address
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
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Dedication
Add 3% to my total amount to help cover the payment processing fees