2009 Membership Form (make check payable to YAPBC)

 All Previous MembersNew Members Only
  Annual Jan - Mar Apr - Jun Jul - Sep Oct - Nov
Regular Single $ 15 $ 15 $ 13 $ 11 $ 9
Family (2 or more people) $ 20 $ 20 $ 18 $ 16 $ 14

My check (#         ) in the amount of $             is enclosed/included.

REQUIRED INFORMATION

Member Name(s):  
Street :  
City, State ZIP :  
Phone : do you want your phone number kept unlisted?   yes   no
Optional Information:
email address :  
What type and how many birds do you own?
 
 
 
Do you breed any of your birds?   yes   no
What activities would you like to see our club do?
 
 
What information do you want or do you enjoy in the newsletter?
 
 
Additional comments
 
 

club use only Date Rcv'd   Card Rcv'd   Entered  
Dedicated to teaching the care, sharing the knowledge, and telling of the love and joy of pet birds.