Strange Birds of Little Rock
Parrothead Application

aka A License To Chill!

Make checks payable to: Strange Birds of Little Rock
Mail to: Tim Simpson, Treasurer
#10 Lynnwood
Little Rock, AR 72206

Today's date:_________________   [ ] Individual Membership            [ ] Couple/family

NAME(S):_______________________________________________________________

ADDRESS: _____________________________Email:___________________________

CITY/STATE/ZIP:________________________________________________________

HOME PHONE:______________________  WORK PHONE______________________

Birthday (s)  Month________________  Day___________________ Name________________
                   Month________________  Day___________________ Name________________
                   Month________________  Day___________________ Name________________
                   Month________________  Day___________________ Name________________

FAVORITE BUFFETT SONG(S)__________________________________________________________
SPECIAL INTRESTS/TALENTS__________________________________________________________

The Strange Birds of Little Rock Parrothead Club is a non-profit organization. We want to help our community and improve the environment we live in.  Let us know what causes/charities you would like to support.

_____________________________________________

How did you hear about the club? ____________________________________________

Individuals may have the opportunity to purchase one or two concert tickets. 
Couples/families may buy up to four tickets if tickets are available
All memberships expire December 31st of each year.

If you join in; January to March - $25 per person/ $30 per couple
April to June - $20 per person/ $25 per couple
July to September - $15 per person/ $20 per couple
October to December - $35 per person/ $40 per couple
(Oct-Dec includes October of the current year to December of the following year)

Visit our web site: www.LittleRockParrotheads.com

“We Party With A Purpose”

The terms Jimmy Buffett, Margaritaville, Parrot Head(s), Parrothead(s), Parrot Head Club,
Parrothead Club and PHC are registered trademarks of Margaritaville Inc.