ISLE O'BAMA PARROTHEAD CLUB
P.O. Box 241991
Montgomery, AL 36124-1991

Membership Form
Single $15 / Couple $25

Name:_____________________________________________________

Address:__________________________________________________

City:__________________State:________________Zip:_____________

Home Phone:__________________Work Phone:__________________

E-Mail:_____________________________Fax:___________________

Birthday:_______________________

I am interested in the following activities:

___Parties ___Writing for Newsletter  ___Hosting Parties
___Producing Newsletter ___Local Community Service ___Club Promotion   ___Natl. Community Service ___Concerts ___Weekend Trips  
___Scuba Diving ___ Deep Sea Fishing ___Camping
Other________________________________________________
____________________________________________________

How did you hear about the club?_______________________________

Is it OK to print your name, Y___N___,address Y___N___,
phone # Y___N___ in the news letter or member directory?

Comments/Helpful hints:_______________________________________

_________________________________________________________

The Obligatory Fine Print:
Each member of the Montgomery Parrothead Club is responsible for his or her own actions and behavior, whether negative or positive. Membership in the club does not give the member permission to use Jimmy Buffett's name, song titles, lyrics, names of businesses or other trademarked, copyrighted or reserved material owned by Jimmy Buffett; nor can any member use the logo of the Montgomery Parrothead Club, Inc. Or Parrotheads in Paradise, Inc. Since Parrotheads are known to enjoy a cold one, we support using a designated driver. This contribution is not deductible as a charitable contribution for federal income tax purposes.