EmailMeForm
2022 GOCBS Membership Form
Please choose your membership and pay here.
New or Renewal
*
Please select
New
Renewal
Date
*
MM
/
DD
/
YYYY
Primary Name
*
First
Last
Primary Email
*
Primary Phone
*
###
-
###
-
####
Primary Phone Roster
*
Please select
Yes
No
Secondary Name
First
Last
Secondary Email
Secondary Phone
###
-
###
-
####
Secondary Phone Roster
Please select
Yes
No
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Type of Membership
*
Please select
Junior Jan-Dec $12.50
Single Jan-Dec $20.00
Family Jan-Dec $25.00
Business Assoc Jan-Dec $25.00
Please note that Junior Membership is 16 or under.
Birthdates (Month and Day Only Please)
Please list first name(s) and birthdate(s) (month and day only). If you have children that would like to see their birthdate announced you can list them here too.
Pet Birds
Do you breed birds?
Please select
Yes
No
Are you interested in fostering?
Please select
Yes
No
Quarantine area available?
Please select
Yes
No
Comments
Please acknowledge the following statement.
*
I understand that this electronic form will use Paypal to complete payment and membership application.
Please acknowledge the following statement.
*
If I click submit below and don't complete PayPal I understand I will need to make other payment arrangements with the membership secretary to complete application.
