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Join the LAPHC phlock as a: *

Primary Member

First Name:	Last Name:
*	*
Birthday (optional):
Address: *
City:	State:	Zip:
*	*	*
Phone:	Is Mobile?:	Email Address:
*		* Would you like to receive club announcements?
Favorite Charity:

Spouse
First Name:	Last Name:

Birthday (optional):
Favorite Charity:		Email Address:
		* Would spouse like to receive club announcements?

Membership Charge: $

Single Parrot... $10
Couple of Parrots... $20

Additional Members / Comments:

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 is responsible for his or her own actions and behavior whether positive or negative. Membership in the Club does not give the Member license to use Jimmy Buffett's name, song titles, lyrics, names of businesses or other trademark, copyright or reserved material owned by Jimmy Buffett. This contribution is not deductible as a charitable expense for federal income tax purposes. Since Parrot Heads have been known to overindulge once in a while, we urge everyone to assign a designated driver.

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