Metro Parrot Head Club Membership Form (Please PRINT)

Name: ____________________________________________________________

Address: __________________________________________________________

________________________________________________ Zip code:__________

Phone: (_____) ______________________________

E-mail address:__________________________________

Occupation: ________________________________________________________

Birthday:  ________________________ (month& day only)

Favorite Buffett Song:______________________________________________

2nd member info:

Last Name: ____________________________ First:_____________________

Birthday: ________________________ (month& day only)

Favorite Buffett Song:______________________________________________

Yearly Dues:  $20.00 Single Membership or $25.00 Family ( 2 people, same address)

Please make checks payable to:
METRO Parrot Head Club and mail to:
Peter Bosshard
6 Mountainview Ct.
Northport, NY  11768

Just print this form on your printer, fill it out and mail it with your payment.

Thanks for your interest in the METRO Parrot Head Club