Washington Area Parrot Head Club

(WAPHC)

Name: ________________________________________

Address: ________________________________________

________________________________________

Telephone: _______________ _______________

Email: ________________________________________

Birth Month/Day: _____/_____

What location do you work: __________________________

(This is to help us in planning activities and meetings)

Dues are $20/year per member. Members must be 21 years old.

Please send this information and your dues check to:

WAPHC Membership

P.O. Box 1075

Springfield VA 22151-0075

or give it to one of our officers at a meeting/social/event.

Check out our event schedule at www.waphc.com

This contribution is not deductible as a charitable contribution for Federal Income Tax Purposes