Membership

MIDWEST BIRD BREEDERS & EXHIBITORS

Membership Application

Type of Membership: q New q Renewal Date:___________________

Single: q 1 year $15.00 q Two years $25.00 / Family: q 1 year $20.00 Two years $35.00

Name:_________________________________ Address:________________________________

City:___________________________________ State:_____________ Zip Code:_____________

Home phone:____________________________ Work phone:____________________________

Cell phone:______________________________ Email:__________________________________

I am interested in the Midwest Bird Breeders & Exhibitors because:

q I have pet birds q I buy birds for resale

q I raise birds for show I own or work in a pet store

q I breed birds for sale as a qhobby or q commercial aviary

q I am a veterinarian, veterinary student or veterinary technician with a special interest in birds

q Other (please specify)__________________________________________________________

Bird species of particular interest and reason (s):

Have as pet Have bred Exhibit Other

1. _____________________________ q q q ___________________________

2. _____________________________ q q q ___________________________

3. _____________________________ q q q ___________________________

4. _____________________________ q q q ___________________________

Other birds owned:_______________________________________________________________

Other bird clubs or conservation organization affiliation:__________________________________

______________________________________________________________________________

I heard about the Midwest Bird Breeders & Exhibitors from:_______________________________

Specialty (breed and/or activity, for Membership Directory Listing):__________________________________

______________________________________________________________________________

Band numbers used (include club issuing band, e.g. SPBE, NCS and breeder code for each type of band):________

______________________________________________________________________________

If you prefer privacy: Please do not include my: (q name, q phone number, q email address) on the published list.

Make checks payable to:

Midwest Bird Breeders & Exhibitors

Address: P.O. Box 61083

City, ST: Port Huron, Mi. Zip Code 48061-0683

NOTE:

For additional information please contact: clisag@hughes.net or kandsmackey@aol.com