Connecticut Parrot Society Membership Form

Online Membership Form - Signup with PayPal!

Fields with a * are required

Membership Type New Member Renewal
Member Name First * Last *
Address
Street Address *

Address Line 2

City *

State *

Postal / Zip Code *

Country *
Phone - (###) - ### ####
Email * (required unless requesting mail delivery of the newsletter)
List the type(s) of parrots that you own *
How did you hear about the Connecticut Parrot Society, Inc? *
Do you have any special talents or skills that you would like to share (Arts, Web, Typing, Cooking, Legal, etc) ?
Please list your family member names and ages (Family Membership Only)
Would you be interested in volunteering for CPS? Yes No
Membership Fees Single (one adult only) $25.00 Family (2 adults and children) $30.00