NCPHC Membership

North Coast Parrot Head Club

Cleveland, Ohio

Read the club By-Laws on the web site:

MEMBERSHIP APPLICATION: Check one:

Single______

Family______

(2 adults and/or dependent children under 24 years old living in same residence.)

Renewal: ___ New Member: ___

Name: __________________________________ Birthday (m/d/yr) _____________

Email: __________________________________ Phone______________________

Name: __________________________________ Birthday (m/d/yr)_____________

Email:___________________________________ Phone______________________

Name: Dependent Children ____________________ Birthday (m/d/yr.)__________

Address: ______________________________________________________________

City ____________________________________ State __________ Zip ___________

By joining the North Coast Parrot Head Club, I (we) certify that we have read the club

bylaws and adopted policies and agree to abide by them as a condition of our membership.

Signature: __________________________________________ Date: _______________

Signature: __________________________________________ Date:_______________

Are you a previous or current member of other Parrot Head Club

chapters? If so, please list them here: _______________________________________

Favorite Jimmy Buffett song: _______________________________________________

Favorite Charity:__________________________________________________________

Do you have any Special Talents you wish to contribute? _______________________

This membership fee is not deductible for federal income tax purposes.

Family Membership: $40/year Renewal is $40.

Single Membership: $30/year Renewal is $30.

Membership renewals are due the first of the month following your join anniversary date.

CONGRATULATIONS! YOU’RE NOW A MEMBER! GET INVOLVED –

Rev 12/14/11

IT'S EASY!

To join, just print out this page.

Fill out the information and write your dues check payable to: North Coast Parrot Head Club.

New member dues are $30 for a single membership and $40 for a family membership (2 adults and/or dependent children under 24 years old living in same residence.)

Mail the form and dues to:

North Coast ParrotHead Club

P.O. Box 31451,

Independence, OH., 44131