Text Box: Date: ________________ Dues are $25/person or $35 per family residing at the same Name(s): ___________________________________________ address. Dues are NOT tax deductible. Please send completed Street Address: ____________________________________ form with check to: City: _________________________________ Parrot Head Club of Charlotte State: _________ Zip Code: ________ c/o Ron Robinson Birthday(s): ____________________________ 19732 Valiant Way Email address(es): _________________________________ Cornelius, NC 28031 If you are involved in a charity or have a favorite, please let us know: _______ _________________________________________________________________________ _________________________________________________________________________ Please let us know if you have any interests or hobbies you would like to share: ______________________________________________________________ _____________________________________________________________________ Text Box: Membership Application Parrot Head Club of Charlotte North Carolina