KVMR's Printable Membership Form

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The form below will print on 2 pages. Click here for an Adobe .pdf form that will print on 1 page.

Please fill out the Membership form, then print and mail it to KVMR's office at;

401 Spring Street,
Nevada City, CA 95959
ATTN: Membership

Or Fax it to;
(530) 265-9077
First Name  * 
 Last Name  * 
 Phone  * 
 
Address  * 
 State  * 
 Zip  * 
   E-Mail
City  * 
 Country  * 
 * Have you ever been a KVMR Member?
                    Yes         No
Choose a Membership level (check one)  * 
$25 Senior,

Student		 $40

Friend		 $60

Advocate		 $89.50

Supporter		 $120

Sustainer		 $300

Benefactor		 $600

Patron		 $1000

Charter
Check here to make an additional donation.      Additional Amount Donated
$120.00 Sustainer level Thank You Gifts
Paul's Collection of Live and Real Concerts · 4-CD Set Paul's Collection of Live and Raw Concerts, 4-CD Set
Paul's Party Pak, 4-CD Set Larry Hillberg, The Long Walk Home, 3-CD Set
Michael Franti and Spearhead Live from New Folsom Prison 11/23/05 2-DVD Set
$89.50 Supporter level Thank You Gifts
Austin Lounge Lizards On The Road LIVE! from The Palms 10/15/04 2-CD Set Todd Snider and The Nervous Wrecks The Nugget, 2-CD set
Michael Franti and Spearhead Live from New Folsom Prison 11/23/05 2-CD Set John McCutcheon GV Vet\'s Hall Jan. 26, 2007 - 2-CD Set
$60.00 Advocate level Thank You Gifts
KVMR's People Powered Radio Tote Mel Walsh, Hot Granny, Book
KVMR's People Powered Radio T-Shirt Behind Harmony Ridge CD
Paul's Collection of Live and Raw Concerts Disc 1 - 2, 2-CD Set Paul's Collection of Live and Raw Concerts Disc 3 - 4, 2-CD Set
Paul's Party Pak Volume 1 & 2, 2-CD Set Paul's Party Pak Volume 3 & 4, 2-CD Set
Paul's Collection of Live and Real Concerts, Disc 1 - 2, 2-CD Set Paul's Collection of Live and Real Concerts, Disc 1 - 2, 2-CD Set
A Baker's Dozen CD Steve Baker's 10th Anniversery Sampler CD
Jimmi Accardi Rare Rock and Roll Vol 1. Rhythm and Blues Jimmi Accardi Rare Rock and Roll Vol 2. Rockabilly
Jimmi Accardi Rare Rock and Roll Vol 3. Rhythm and Blues Jimmi Accardi Rare Rock and Roll Vol 4. Rock, Rockabilly
Jimmi Accardi Rare Rock and Roll Vol 5. Blues, Rhythm and Blues Jimmi Accardi Rare Rock and Roll Vol 6. Rockabilly, Rhythm and Blues
Jimmi Accardi Rare Rock and Roll Vol 7. Jumpin Blues Jimmi Accardi Rare Rock and Roll Vol 8. Rockabilly
Jimmi Accardi Rare Rock and Roll Vol 9. Roots of Rock Jimmi Accardi Rare Rock and Roll Vol 10. Roots of Rock
Jimmi Accardi Rare Rock and Roll Vol. 11. Early Rhythm and Blues Jimmi Accardi Rare Rock and Roll Vol. 12. More Early Rhythm and Blues
Jimmi Accardi Rare Rock and Roll Vol. 13. Rock and Rhythm Jimmi Accardi Rare Rock and Roll Vol. 14. More Rock and Rhythm
Jimmi Accardi Rare Rock and Roll Vol. 15. The Birth of Rock Jimmi Accardi Rare Rock and Roll Vol. 16. The Birth of Rock
Molly Fisk, Using Your Turn Signal Promotes World Peace CD Greg Brown with Bo Ramsey Live, Grass Valley Vets Hall, 5/8/2003
HOW WOULD YOU LIKE TO PAY FOR YOUR MEMBERSHIP OR DONATION?
Check enclosed Invoice in Full ** 12 EFT Installments Credit Card
Card Type: VISA: MC:
Card Number: Expiration Date:
Name on Card: Your Signature:
_______________________
**If you choose EFT (Electronic Funds Transfer), your pledge is divided into 12 automatic monthly deductions taken directly from your checking account; minimum $60 pledge. You will receive a pledge statement and EFT information in the mail.