Member Application

Parrot Heads of Citrus, Inc.

Membership Application

We Party with a purpose! Let's leave the World a little better than

we found it & have a blast doing it!

PLEASE PRINT OUT & COMPLETE THIS FORM & SEND TO ADDRESS BELOW

Check the appropriate box: New member [___] Renewal [___]

ONE person per application.

Name:______________________________________ Nickname:_______________ DOB (MM/DD)_______________

Address:____________________________________

City:_______________________________________ State:______ Zip:_________

Home Phone:______________________________ Cell Phone:____________________________

Email Address:____________________________

Annual Membership dues are $20.00 per Person.

Renew on or before your anniversary date of each year & get $5.00 off.

The success of any club depends on its' membership volunteering on various projects, activities & events. Are you willing to lend a hand in the planning & success of any activities below:

Club Promotion ____ Writing for the Newsletter ___ Hosting Parties ___ Local Community Service ___

Beach Clean Ups ___ River Clean Ups ___ Fund Raising Events ___

Are you or anyone you know a musician & interested in performing for the club? _________________

For further information please call:

Membership Director, Captain Horace Warren @ 352-201-0142

or Judy Foxworth,@ 352-527-9007

parrotheadsofcitrus.org

Make Checks Payable to: Parrot Heads of Citrus, Inc.

Mailing address: PO Box 1543 Crystal River, FL 34423

Name:______________________________ Nickname:_ DOB (MM/DD)_________

Address:____________________________________

City:_____________________________ State: Zip:_

Home Phone:__ Cell Phone:

Email Address:____________________________

The success of any club depends on its' membership volunteering on various projects, activities & events. Are you willing to lend a hand in the planning & success of any activities below:

Club Promotion __ Writing for the Newsletter _ Hosting Parties _ Local Community Service _

Beach Clean Ups _ River Clean Ups _ Fund Raising Events ___

Are you or anyone you know a musician & interested in performing for the club? _________________