Omaha Nebraska Parrot Head Club Membership Application Renewal Only!

·         Dues received are valid for ALL OF 2008.  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.

·         You will receive your new ID card after December 2007.

Renewal application only, do not use for new applications.  Is this a joint or single membership? _________

Name: ___________________________________________________________________________________

Name: For second person, joint apps: ___________________________________________________________

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 (ONPHC)

Mail this application and check or money order to:

Frank Siedlik

16824 Pierce St.                                 Date Paid ____________  Check # _____________  Amount ___________

Omaha, Ne.  68130

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; any member will help you get one for your use.

 

 

Omaha Nebraska Parrot Head Club Membership Application Renewal Only!

·         Dues received are valid for ALL OF 2008.  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.

·         You will receive your new ID card after December 2007.

Renewal application only, do not use for new applications.  Is this a joint or single membership? _________

Name: ___________________________________________________________________________________

Name: For second person, joint apps: ___________________________________________________________

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(ONPHC)

Mail this application and check or money order to:

Frank Siedlik

16824 Pierce St.                             Date Paid ____________  Check # _____________  Amount _________

Omaha, Ne.  68130

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; any member will help you get one for your use.