Membership Application Form 

Name_________________________________________________________ 

Address_______________________________________________________ 

City_________________ State ____________ Zip ______ 

Phone________________________________________________________  

E-mail________________________________________________________ 

WEB__________________________________ 

(Please Check all that apply) 

_____Poet  _____Musician  ____Single Act ____Duo/Group 

Name of Group__________________________________ 

_____Fan (Non-performing member) 

New Membership_______($20.00)      Youth (under 18) __________($5.00) 

Renewal Membership_______($15.00) 

Couple/family membership________($30.00) 

Couple renewal membership ________($25.00) 

(member names for couple)______________________/____________________ 

Tell us about yourself (use the back if more room is needed!): 
 
 
 
 
 
 
 Please make check payable to Cowboy Poets of Utah - Mail to:  Keri Carter 25 North 780 West  Lehi, Ut. 84043

Renewal Memberships are due March 1