Dues
are as follows:
·
Single applications are $15.00. Joint memberships are $20.00
·
Members must be at least 21 years of age
Is
this a new single or joint membership? ______________
Name:
_________________________________________________________________________________
Address:
_______________________________________________________________________________
City:
Home
Phone: _________________________________Work Phone:
________________________________
E-mail
Address: __________________________________________________________________________
Birth
date (mm/dd/yy): ___________________ Occupation: _______________________________________
Favorite
Buffett song_______________________________________________________________________
How
did you hear about us? ______________________________Referred by: ________________________
Check all of the areas where you would be willing to
help:
Newsletters Recruiting Public
Relations Social
events Service
projects I just want
to party
Second Applicant information for joint memberships:
Name:
__________________________________________________________________________________
Address:
________________________________________________________________________________
City:
Home
Phone: _______________________________
Work Phone: _________________________________
E-mail
Address:___________________________________________________________________________
Birth
date (mm/dd/yy):________________Occupation_____________________________________________
Favorite
Buffett song________________________________________________________________________
How
did you hear about us? _____________________________Referred By:
___________________________
Check all of the areas where you would be willing to
help:
Newsletters Recruiting Public Relations Social events Service projects I just want to party
I would like the Beak’n
Newsletter in: _____ paper form _____ e-mail form ______ both
Make checks payable to: OMAHA NEBRASKA PARROT HEAD CLUB(ONPHC) www.omahaparrotheadclub.com
Mail this application and check or money order to:
Frank Siedlik
Now the disclaimer: The state incorporation of the Omaha Nebraska Parrot Head Club requires that members be at least 21 years old. This contribution is NOT deductible as a charitable contribution for tax purposes.