To become a member of the PHOCK Group. Please fill out the below form and email to us or bring a printed version it to our next meeting.  


*** Make check out to Parrot Heads of Central Kansas ***

Members Name: :________________________________________  Birthdate: _______________.

Email Address __________________________________________________________________

Phone:  _____________________(H)  _____________________(C)  _____________________(W)

Street Address:  __________________________________________________________________

State:  ___________________________  Zip Code:  __________________

Please indicate your choice of the three categories for membership:

____ Administrative - want to come to meetings and vote on club matters

____ Volunteering - want to plan and/or help with charitiable activities

____ Social - only want to show up at activities (assumed if no choice is made)

Are you interested in any of the following activities?

____ Parties   ____ Hosting parties  ____ Concerts  ____ Weekend Trips ____ Outdoor Activities

____ Writing a Newsletter   ____  Editiing a Newsletter ____ Admin a Webpage

____ Organizing Events   ____ Local Community Service  ____ National Community Service  

Your Interests/hobbies: ________________________________________________________________


Skills you are willing to offer the club: ______________________________________________________


Each member ot the Parrot Head of Central Kansas Club is responsible for his or her own actions and behavior and shall treat fellow members, guests, and hosts (including personal property) with the utmost respect.  Members agree to abide by all local, state, and federal laws.  Members are to abide by all the Bylaws of the Parrot Head of Central Kansas club.

Membership to the club does not give the member permission to use Jimmy Buffet's name, song titles, lyric, name of businesses, or other trademarked, copyrighted, or reserved material owned by Jimmy Buffet; nor can any member use the logo of the Parrot Heads of Central Kansas or Parrotheads 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: __________________________