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/CELL: ___________________________

                                          EMAIL: ____________________________________  WEB URL: __________________________

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 about 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