MEMBERSHIP APPLICATION

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

A TOUCH OF ITALY

355 BROADWAY

AMITYVILLE, NY 11701

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     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

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