Capital Region Parrot Society 

We are for the birds!     

2016 MEMBERSHIP/DONATION FORM FOR THE CRPS

NEW MEMBER?________OR RENEWAL?_________  DONATION_______DATE:___________________
Suggested Donation: 1 year: $20.00 or 3 Year special: $55.00
(Please give this form to a potential new supporter if you have already made your contribution!) NAME/S:___________________________________________________________________________
ADDRESS:_________________________________________________________________________
CITY:___________________________________________STATE:__________ZIP:______________ PHONE (preferred):__________________________________________________________________
ALTERNATE PHONE:______________________________________________________________________
EMAIL: (please print clearly):____________________________________________________________
LIST THE TYPE OF BIRD/S YOU HAVE (or are interested in):______________________________ ___________________________________________________________________________________
ARE YOU INTERESTED IN PROVIDING FOSTER CARE?    YES_________NO_________
ARE YOU INTERESTED IN PET BIRD ADOPTION?    YES__________    NO_________ _
ARE YOU INTERESTED IN ASSISTING WITH PET BIRD RESCUE?    YES________ NO________
ARE YOU AVAILABLE FOR THE LOST BIRD HOTLINE? YES____________NO_____________
ARE YOU A BREEDER? YES______________    NO_________________
YOU WILL BE ADDED TO OUR ROSTER AND WILL RECEIVE NEWSLETTERS and/or EMAIL NOTIFICATIONS and/or PHONE CALLS (if you provided contact information).
ALL PROCEEDS ARE USED FOR BIRD RESCUE, MEDICAL CARE, EDUCATIONAL MATERIALS, HANDOUTS, POSTAGE, AND ORGANIZATIONAL FEES PLEASE NOTE: Donations in any amount & at any time are greatly appreciated! KINDLY MAIL THIS COMPLETED FORM WITH YOUR CHECK TO:

MEMBERSHIP SECRETARY
CAPITAL REGION PARROT SOCIETY, INC.
P.O. BOX 2433
MALTA, NY 12020

On behalf of our feathered friends, thank you for your support!