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Membership

Date:

 

Qty

Total

INDIVIDUAL MEMBERSHIP @ $15.00 per person ($5 student) 

$

FAMILY MEMBERSHIP @ $20.00 for parents/children

$

HBC PILEATED WOODPECKER CLUB PATCH @ $5.00 each
With an easy iron-on backing, it's great for knapsacks, tote bags or vests!

$

HBC Decal @ $3.00 each
easy self-stick to car window!

$

DONATION TO THE MARILYN FLOR DAY CAMP SCHOLORSHIP FUND

 

$

DONATION TO THE AUXILIARY FUND for walkie-talkies, videos and other items for club members to use.

 

$

 

 

 

TOTAL ENCLOSED

 

$


Name[s]:

Address:

City:

State:

Zip:

Telephone Number:

Home: Work:

Email Address:

Do you wish to be on the EMAIL hotline?

Do you wish to be on the telephone hotline?

Do you wish to be included on a membership list shared with other members only?

 

. Students under 16 must be accompanied by a designated adult.

. Members who first joined after April 2004 are good for 2005.

. Please make checks payable to The Hoffmann Bird Club and send along with this form.

 

Please fill out this form, print it and return to:

F. Thomas Collins

 

93 Quirico Dr.

 

Pittsfield, MA 01201

Thank you very much and good birding !