Washington Area Parrot Head Club

(WAPHC)

I Wanna Be A Parrot Head!!!

 

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