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.