| All rights reserved. |
| 2011 Membership Form Acadiana Bird Club, Inc. P.O. Box 52244 Lafayette, La 70505 Acadiana Bird Club, Inc. was formed to promote the health and well being of all pet and breeder birds. Our goals are the preservation of all bird species through public education on the proper care and breeding of birds. Please join us and help attain these goals. Dues shall be paid by February 28th. Dues are $25 and are non-refundable. Name: ______________________ Date: _________________ Address: ______________________________________ City: ________________State: ______ Zip: ________ E-Mail Address: _______________________ Phone Number (____) ___- _____ Birth date Month/Day _________ Anniversary Month/Day_________________ Membership Type: New Renewal Type of Membership: Family (two votes) Single Adult Type of birds that you own: __________________________________________________________________________ __________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Can the above information be printed in our membership roster? Yes No The roster is for members only and is not sold or disclosed to anyone outside of our membership. May your birthday/anniversary be printed in the new letters? Yes No Pictures are sometimes taken at club functions; if pictures are taken of you and or your birds can they be printed in the monthly newsletter? Yes No May we list you as a vendor on our web-site? Yes No |
 | |  | |  | |  | |  | |  | |  | |  | |  |