|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: _________________
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
your e-mail _______________________________
May we list you as a vendor on our web-site? Yes No