Parrot Head Membership

For Membership Information, you may contact us at lorainenelson@bellsouth.net or return this application to us (see address below)

PHINS Parrot Head Club, Jacksonville, Florida

Membership Application

$30 Family Membership _______ $20 Single Membership _______

CHECK # ________ CASH ________ Date Paid ____________ MEMBER NAME(s): _______________________________________________ ADDRESS: __________________________________________ZIP__________ PHONE NUMBERS: (HOME) ______________________________ (WORK) __________________ (CELL) _____________________ E-MAIL Address__________________________________________ DATE(s) OF BIRTH (Month and Day) _________________________

PARAKEETS

NAME: ___________________________________DOB:__________

Please bring this form to a Social PHlocking at Lillian’s – First Wednesday of each month or mail to:

PHINS, 6327 Ortega Farms Blvd. Jacksonville, FL 32244