Membership Application
To join using US Mail: If you prefer to print the membership application and send via U.S.P.S.
Click here for the application in Adobe PDF format Download Tip Opens in a new browser window. You can print it out right away, or use the "Save a Copy" icon and print it later. If you do not have Adobe Reader installed on your computer, you can download it for free here.
Click here for the application in MS Word format Download Tip You will have the choice to "Open" or "Save". For best results, choose "Save", then select an easy to remember location, such as "Desktop". This is a good choice if you have Microsoft "Word" installed on your computer.
To join online: If you prefer to fill out the application and pay securely online, please continue.
Your Name
Your Birthday
Spouse/Significant Other/Friend
Their Birthday
Additional members in household
Additional members' birthday(s)
Your Occupation:
Street Address or PO Box		Do Not Share
City		Do Not Share
State	Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Do Not Share
Zip		Do Not Share
PRIVACY Please check any information that you do not want to be shared with other members. NOTE: E-mail is our primary method of distributing club information (social events, community service, meetings, etc.)
E-mail		Do Not Share
Home Phone		Do Not Share
Work Phone		Do Not Share
Cell Phone		Do Not Share
Pager		Do Not Share
FAX		Do Not Share

DUES
$20 - Single membership
$30 - Couple    
$35 - Family
$10 - Out of state membership (per person)

Membership dues will be for the period of one year. You will receive a bill when your dues are up for renewal. Couple and family dues are based on persons living at the same address. Dues are not deductible as a charitable expense for federal income tax purposes.     

DISCLAIMER
Each member is responsible for his or her own actions and behavior as well as that of their parakeet(s). Membership in the club does not give the member the license to use Jimmy Buffett's name, song titles, lyrics, names or businesses or other copyrighted or reserved material owned by Jimmy Buffett.
  I acknowledge that I have read and understood the above disclaimer.

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