Barefoot Children Parrot Head Club - 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
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	(required)
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		Do Not Share
Zip		Do Not Share
PLEASE NOTE E-mail is our primary method of distributing club information (social events, community service, meetings, etc.)
E-mail(s)	(required)	Do Not Share
Home Phone		Do Not Share
Cell Phone		Do Not Share
How did you hear about us?
If you selected "other", please specify:

DUES- after July 1st dues are Half Price for the remainder of the year.

Single Membership	Couple Membership	Family Membership	Out of Town Membership
January – June $20.00	January – June $30.00	January – June $35.00	January – June $10.00 per person
July – December $10.00	July – December $15.00	July – December $17.50	July – December $5.00 per person

Membership dues are renewed every Dec 31st for the following 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 of businesses or other copyrighted or reserved material owned by Jimmy Buffett.

I acknowledge that I have read and understood the above disclaimer. (required)

You can pay the membership fee securely online after pressing the "Continue" button.