NAME:_____________________________________________________


     ADDRESS:___________________________________________________                             

                         ___________________________________________________


     PHONE NUMBER:_____________________________________________


    EMAIL ADDRESS:  ____________________________________________


    NEW MEMBER:_____   RENEWAL:_____    


​    MEMBERSHIP#:_______     DATE:___________________  


     DO YOU WANT YOUR EMAIL OR PHONE # MADE AVAILABLE TO OTHER MEMBERS?   YES: ______  NO:  _______


SEND $15.00 ANNUAL DUES TO:


PARROT FANCIERS CLUB  

P.O. BOX 128

 AMITYVILLE, NY      11701









MEMBERSHIP APPLICATION

MEETINGS ARE THE 1ST FRIDAY OF EACH MONTH FROM 6:00 PM - 8:00PM


A TOUCH OF ITALY

355 BROADWAY

AMITYVILLE, NY 11701


Title

Subtitle

Type your paragraph here.