Membership / Information Form

{New Member} □ [Renewal] □

 Date________________________________

Name_______________________________________________________________________

 Address_____________________________________________________________________

 City ________________________________________State ____________Zip_______-______

 Telephone # (______) ____-________ E-Mail _______________________________________

Check one below:

□YES, place my information on the club member listing page on the club web site. 
The only information that will be placed on the web site is your name, phone number and e-mail address if you have one, and a list of the breeds and varieties of poultry that you have.              □ NO, DO NOT place my information on the club member listing page on the club web site. 

Family membership: Please list spouse and children names and give D.O.B. for each child under 18.

_____________, ___________, ___________, ___________, _____________.

What birds do you have? Please list Breeds & Varieties on this form or and attached sheet.

_____________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________

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Mail form to:

Carolina Feather Fanciers Association                                                                                                                                                                                   
c/o Lynn Hines, Treasurer   

3324 Belmont Mt. Herman Rd #5Burlington, NC 27215-8861

DUES ARE: Individual One Year $7.50, Three years $21.00.  Family One year $7.50, Three Years $21.00.

Junior Individual: Free until 18 birthday. All dues are due on January 1 of each year.  The prorating as follows.

January $7.50, February $6.88, March $6.25, April $5.63, May $ 5.00, June $4.38, July $ 3.75, August $3.13,

September $2.50, October $1.88, November $ 1.25, December $ .63

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