Membership Form 2019
PHINdy Parrot Head Club Membership Form
Email address *
Are you renewing your membership? If renewal, please only complete mandatory fields unless information has changed.
First Name Member 1 *
Your answer
Last Name Member 1 *
Your answer
Birthdate
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First Name Member 2
Your answer
Last Name Member 2
Your answer
Birthday Member 2
Your answer
Parakeet Names (your children's names for family membership)
Your answer
Parakeet Birthday(s)
Your answer
Street Address *
Your answer
Street Address 2
Your answer
City *
Your answer
State *
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Zip Code *
Your answer
Email Address Member 2
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Cell Phone Member 1
Your answer
Cell Phone Member 2
Your answer
Membership Type Pay by mail.
Pay by mail by mailing to PHINdy PHC of Indianapols PO Box 852, Indianapolis IN 46206
If paying by mail please check below.
Membership Type pay online
Online Membership Payment can be made at www.phindyphc.com Join the PHLock tab.
Type Of Membership
Individual
Membership is not valid until payment is received.
Once payment is received you will receive a confirmation email.
PHINdy Parrot Head Club Membership Agreement.Completion of an application and payment of dues is your consent to membership in this organization. As amember you agree to bylaws adopted by the membership of the PHINdy Parrot Head Club as well as ParrotHeads In Paradise, Inc., and the use of your application information by the club for matters pertaining to itsoperation and events.Activities organized by the club are for enjoyment of the membership, the PHINdy Parrot Head Club. Ourofficers or members are not liable for any injury, loss or damage of personal property. Each member isresponsible for his or her own behavior as well as that of their children. PHINdy Parrot Head Club, its membersand its officers will not be responsible for your actions during your association with the organization.Membership fees are not deductible as a charitable contribution for Federal Income Tax purposes per PHIPbylaws.The terms Jimmy Buffett, Margaritaville, Parrot Head(s), Parrothead(s), Parrot Head Club, Parrothead Club andPHC are registered trademarks of Margaritaville Inc. Pursuant to the request of HK Management, The HowardRose Agency, and Margaritaville Holdings, Inc., NO club member, founder, or club president is authorized tocontact any of these organizations regarding Jimmy Buffett concert tickets or any other matter pertaining toParrot Heads in Paradise, Inc. Any and all communication shall be through Parrot Heads in Paradise, Inc. - Read? *
Electronic Signature *
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Date *
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Tell us about yourself. Buffett experiences? Hobbies? Profession? What are you looking for in a club? Are you interested in being involved in our charitable work?
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