WNC Parrot Head Membership Form

Western North Carolina Parrot Head Club
MEMBER REGISTRATION

The collected member info is kept strictly confidential. Only fully completed forms are accepted.
Step #1 - Fill out the Membership application form below and submit it.

Step #2 - Follow the payment instructions below the membership application form. You can pay online or mail a check.

Note: "This contribution is not deductible as a charitable contribution for Federal income tax purposes."
Name*

First NameLast Name
Cell Phone Number*
Address*

Street Address

Street Address Line 2

CityState

Zip
E-mail*

Confirmation EmailExample: yeap@csaaeinc.org
Are you are involved with any charities or have a favorite?
How did you hear about us?
Payment by:*

Credit or Debit CardMail Check
Please verify that you are human*
Mail Check to:

WNCPHC

c/o Sandy Kayser

23 Eagle Lane

Candler, NC 28715

My Products*

September - December 2024 Single Membership

$12.00 Quantity
Item subtotal:$0.00

September - December 2024 Couples Membership

$24.00 Quantity
Item subtotal:$0.00

Donation(Not tax deductable)

$1.00 Quantity
Item subtotal:$0.00

Total

$0.00

Credit Card

Apple Pay

Google Pay

Western North Carolina Parrot Head Club