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Please complete all information, even if it has not changed. This helps us keep our records current.

Join the LAPHC phlock as a: *

	Primary Member	Co-Member
First Name	*	*
Last Name	*	*
Nickname (for Laminate)
Birthday
Email Address	* Would you like to receive club announcements?	Would you like to receive club announcements?
Cell Phone
Shirt Size	*	*

Address: * Home Phone: *

City: * State: * Zip: *

Membership Charge: $

Dues are for the calendar year and not prorated for partial year membership. Renewals are due January 1st of each year.

Names of Additional Members / Comments:

Membership Fees are not deductible as a charitable expense for federal or any other tax purposes.

By clicking "submit" below, you are stating that you understand and agree to the following statement:

Each member of the Los Angeles Parrot Head Club (LAPHC) is responsible for his/her own actions and behavior. Parrot Heads in Paradise (PHiP) and LAPHC do not permit the use of Jimmy Buffett's name, song titles, lyrics, trademarks or copyrighted or reserved materials of business owned by Jimmy Buffett or other related companies. Members may not use the club name or logo for any purpose other than designated club plublications, items or events without written permission from the Board of Directors. No member may use the PHiP name or logo without their written permission. Additional restrictions, including but not limited to our bylaws may also apply.

If you've changed your mind, click "Clear"

To send you payment by mail, click "Just Send Email". You will receive an email welcoming you to the
club with a copy of the application attached. Just print the email out and send to the postal address provided.