Coosa Landsharks Parrot Head Club

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Coosa Landsharks Parrot Head Club

P.O. Box 8603

Gadsden AL  35902

www.coosalandsharks.com

Membership Application

Single $24/Family $36

Name(s):_____________________________________________________________________________________

Address:_____________________________________________________________________________________

City:________________________________________State/Zip:________________________________________

Home Phone:_________________________________Work Phone:______________________________________

E-Mail Address:_________________________________________Fax:___________________________________

Birthday(s):___________________________________________________________________________________

I am interested in the following activities:

__Parties __Writing for Newsletter __Producing Newsletter __Hosting Parties

__Local Community Service__National Community Service__Club Promotion

__Concerts__Weekend Trips__Outdoors Activities

Other____________________________________________________________

How did you hear about the club?______________________________________

Comments:________________________________________________________

The Obligatory Fine Print:

Each member of the Coosa Landsharks Parrot Head Club is responsible for his or her own actions and behavior and shall treat phellow members, guests and hosts and their personal property, with respect.  Members agree to abide by all local, state and federal laws.  Members agree to abide by all the Bylaws of the Coosa Landsharks Parrot Head Club.

Membership in the club does not give the member permission to use Jimmy Buffett’s name, song titles, lyric, names of businesses or other trademarked, copyrighted or reserved material owned by Jimmy Buffett; nor can any member use the logo of the Coosa Landhsarks Parrot Head Club, or Parrot Heads 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_________________________Signature/date__________________________