Dues received are valid for the
year ending 12/31. The cost is $15.00
for single membership and $20.00 for joint membership. Please fill in your name(s) and any
information which may have changed.
Renewal application only, do
not use for new applications. Is this a single
or joint renewal? ____________
Name:
___________________________________________________________________________________
Name:
For second person (joint app): __________________________________________________________
Address:
__________________________________________________________________________________
City:
__________________________State: _______ Zip: ____________Home Phone:
___________________
Work
Phone: ___________________________ Second person work phone:
____________________________
E-mail
Address: ____________________________________________________________________________
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
Make checks payable to: OMAHA NEBRASKA PARROT HEAD CLUB or (ONPHC)
Mail this application and check or money order
(please do not send cash through the mail) to:
Frank Siedlik
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.
New applicants please use the full application.
www.omahaparrotheadclub.com
For Office Use: Date Paid ____________ Check # _____________ Amount ___________