Sanctuary Application
Completed application form must be sent with payment. Please fill in all fields below that apply.
Name of Property *
Your answer
City, State, Zip Code *
Your answer
County *
Your answer
Acreage *
Approximate Number of Acres
Your answer
INFORMATION ABOUT PROPERTY
Approximately what percentage of the property is comprised of the listed type of land.
Farm
Your answer
Field
Your answer
Pasture
Your answer
Woods
Your answer
Name of Owner *
Your answer
Street, RD or Box # *
Your answer
City, State, Zip *
Your answer
E-mail Address or Phone # *
Your answer
Type your name and the date below to indicate your understanding of and agreement with the following statement:
I DECLARE MY INTENTIONS OF DOING MY BEST TO SEE THAT THE PROPERTY IS TREATED
AS A WILDLIFE SANCTUARY AS LONG AS THE BBC SIGNS ARE USED TO POST IT.

I understand and agree that the use of these sigs does not give the Brooks Bird Club, Inc. (BBC) any rights whatsoever over the lands on which the signs are erected, nor does it in any way place any liability upon the BBC with respect to the use of such lands.

Electronic Signature
Full Name *
Your answer
Indicate the number of sanctuary signs you desire. *
Signs are $5.00 each plus $3.50 for shipping. WV residents must additionally pay $0.35 tax per sign.
Your answer
Method of Payment *
* Checks are made payable to: Brooks Bird Club Inc. Mail to: Cindy Ellis 3114 Steel Ridge Rd. Red House, WV 25168-7724
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