Barefoot Children Parrot Head Club - Renewal Application

Name	(required)
Street Address or PO Box
City
State
Zip
E-mail	(required)

DUES

$20.00 - Single membership
$30.00 - Couple
$35.00 - Family
$10.00 - Out of town 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.
*Renewals are due by Jan 1st for the upcoming year.

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