Ark-La-Tex Caged Bird Club Membership Application

NEW MEMBER______ RENEWAL ______

MEMBERSHIP: SINGLE $15.00 ______ HOUSEHOLD $20.00 ______

NAME: __________________________ HOME PHONE: ________________________

ADDRESS: _______________________ WORK PHONE: _______________________

CITY, STATE, ZIP: _________________ FAX: ________________________________

EMAIL: __________________________ Web Address__________________________

Do you want to be listed in the Club Directory?    YES    NO

(Please circle one, if you do not, it will be assumed that you do not want to be added to the directory)

Type of Birds Breeders Pets Pet’s Names
       
       
       
       

If this is not enough room, please list additional birds on the back of the page.

If you are a breeder, do you want your name and number given to people who are looking for birds?    YES   NO

Would you like to show and tell your bird at a meeting?   YES   NO  If yes, please list birds below.

 

TOPICS YOU WOULD LIKE THE CLUB TO COVER:  (e.g. breeding, nutrition, hand-rearing, etc.)

 

PLEASE SHARE SUGGESTIONS FOR POSSIBLE CLUB ACTIVITIES:

 

SIGNATURE: ________________________________ DATE: ________________

BRING THIS FORM TO THE NEXT MEETING, OR PLEASE MAIL WITH A CHECK TO:

ARK-LA-TEX CAGED BIRD CLUB

P. O. BOX 5235

SHREVEPORT, LOUISIANA 71135