Membership Form


New Smyrna Beach Parrot Head Club

New Member Application & Renewal Form                                                                      

_______ $20 Single   ________  $35 Couple    _______ $10 per Keet (Child)

Name #1_______________________________________________________________________


Name #2: ______________________________________________________________________ 


Mailing Address: ________________________________________________________________


City: _______________________________________State: _____________Zip______________              

E-mail #1____________________________________________________________________­­­­­­­­­­­­­­­_


E-mail #2______________________________________________________________________ 


Phone #1 _________________________ (home) _______________________________ (cell)


Phone #2 _________________________ (home) _______________________________ (cell)


Birthday (Month/Day): #1: __________________________    #2: _____________________


Keets  (Names & Birthdays): _____________________________________________________


Bring Checks to Phlocking, Payable to New Smyrna Beach Parrot Head Club,   


  Each member of the NSBPHC is responsible for his or her own actions and behavior and shall treat Phellow members, guests, and hosts and their personal property, with respect. Members agree to abide by all local, state, and federal laws. Members agree to abide by all the Bylaws of the New Smyrna Beach Parrot Head Club.


Membership in the club does not give the member permission to use Jimmy Buffett’s name, song titles, lyric, names of businesses or other trademarked, copyrighted, or reserved material owned by Jimmy Buffett; nor can any member use the logo of the New Smyrna Beach Parrot Head Club, Inc. or Parrot Heads in Paradise Inc.


Since Parrot Heads are known to enjoy a cold one, we support using a designated driver.
​ This contribution is not tax deductible as a charitable contribution for federal or state income tax purposes.






Signature _____________________________________________________Date_____________

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