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2014 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
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  
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