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.  

ANNUAL MEMBERSHIP IS $20 PER PERSON (PLEASE PAY BY CHECK or VENMO)

Cost to join pro-rated: Jan-Mar $20 / Apr-June $15 / July-Sept $10 / Oct-Dec $5

      CHECK - Make check out to Parrot Heads of Central Kansas or PHOCK

      VENMO - @Pamela-Winters-6 (message Parrot Head Membership)

Members Name: :________________________________________  Birthdate: _______________.

Email Address __________________________________________________________________

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

Street Address:  _________________________________________________________________

City: ___________________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 charitable activities

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

Are you interested in any of the following activities?

____ Admin a Webpage ____ Writing a Newsletter ____ Editing a Newsletter

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

____ Organizing Events ____ Local Community Service ____ National Community Service  

Your Interests/hobbies: ________________________________________________________________

__________________________________________________________________________________
__________________________________________________________________________________

Skills you are willing to offer the club: ______________________________________________________

__________________________________________________________________________________

Each member at 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 or Uber, Lift etc... 

This contribution is not tax deductible as a charitable contribution for federal or state income tax purposes.

Signature:  __________________________________  Date: __________________________