Membership Application

To print the application, click the Print Button in your browser window.

Name of Organzation:

Background information, is most helpful for the integrity of the Foundation and its purpose, so please accomodate this request to make your application process quickly

If you'd like more information about the Foundation please contact lucielady@aol.com

Please provide history regarding your breeding birds.

Your Name

Address 1

Address 2

City State Zip

Your home page:

Email
Phone
Foundation member participation: Please hold CTRL Key to make multiple selections. Veterinarian Sponsor Inquiry, choose other.
Aviculture Microbiology Foundation, Inc. Thank you, Board of Directors 1. How did you learn about Aviculture Microbiology Foundation,Inc.? 2. Were you referred to this Foundation by someone? Yes No 3. If so, Who? 4. How long have you been active with birds? 5. Are you a breeder of birds? Yes No a. Pet Owner? Yes No b. Pet Shop Owner? Yes No c. Rescue Birds Unit? Yes No 6. Do you own 10 or less birds? Yes No a. Over ten birds? Yes No 7. Your reason for wanting to join this Foundation? 8. What do you hope to learn and/or accomplish by joining Aviculture Microbiology Foundation,Inc.? 9. If accepted, what will your first contribution be to the Foundation as a member?
Please note species of birds under your care now, or species you have had experience with: Please hold CTRL Key to make multiple selections. If not listed choose other.
Comments.

Name: (please print clearly)
Address:
City:
State:
Zip:
AC/Phone:	( )
Email:
Aviculture History:
Membership	Please only check one (New or Renewal)		Please only check one
	New $50.00	Renewal $50.00		Single - $50.00

Aviculture Microbiology Foundation,Inc.

Make your check payable to:

Aviculture Microbioloy Foudation, Inc

Mail your completed application with your membership dues to:

Aviculture Microbiology Foundation,Inc

Pam Suite, Treasurer

3065 S.E. Darien Road

Port St. Lucie, Fl 34952

DONATIONS ARE TAX DEDUCTABLE

You must follow the policies which will come to you through acceptance by Membership Committee.

Failure to comply according to the guidelines will result in termination/removal of your participation on the discussion list or as a member of Aviculture Microbiology & Foundation, Inc.

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