Ann Arbor Companion Bird Club Membership Application

Please print out this application form, fill it out, and bring it to the next meeting or mail it, along with your check to:

2232 S Main St #183
Ann Arbor, MI 48103

Dues are $20.00 per year for single or family membership, pro-rated to $10.00 after May first. Dues are renewable annually and run from November through October. Make checks payable to ANN ARBOR COMPANION BIRD CLUB.

(Please print legibly)               _____Renewal Application        _____New Application

ADULTS: __________________________________________________________
UNDER 18:_________________________________________________________
CITY:_______________________HOME PHONE:( ___ ) __________________
STATE:_________ZIP:________WORK PHONE:( ___ ) __________________

Would you like to be listed on the annual member telephone list? YES___NO___ (no charge for listing)

Would you like to be listed as a member breeder? YES___NO___ Addresses are not published.

How would you like to be listed -- as above / first name only / full name / with business name / business name only / ? __________________________________________________________________
What phone number(s) _______________________________________________
What kinds of birds do you want listed? _______________________________

NOTE: I hereby apply for membership (new / renewal) in the ANN ARBOR CAGE BIRD CLUB. and agree to abide by the constitution, By-laws and rules of the club. (A copy of this form, signed by all members over 18, is to be kept on file for renewals. ______________________________________________________DATE: ________
DATE: ________

CLUB USE:                     Received: ________________________________________________
Approved: __________________________________________ Date: __________ Cash/Check (#_______ )
Receipt: ____________ Amount: ____________ Card Sent: ____________ List(s) B/T/None
Name Tags needed ____________________________________________________________