Mid American Exotic Bird Society Membership Application



Name _________________________________________________________________________
(List the names of all persons to be included in this membership)

Address ______________________________________________________________________

City _____________________________________________  State ____________________

Phone (______)________________________________________________________________

Email ________________________________________________________________________


Please indicate which of the following pieces of information you wish
to be included in your listing in the Membership Roster (handed out to
members only).

Address _______  Phone _______  Email _______


Please list the birds you own:

Name ______________________  Breed ____________________________  Age _________

Name ______________________  Breed ____________________________  Age _________

Name ______________________  Breed ____________________________  Age _________

(write on back if you need more room)


Please list the birds you breed (if applicable):

______________________________________________________________________________


Type of membership: Single ($18) _______  Family ($24) _______

Make checks payable to: MAEBS
Mail payment and form to:

Pat Andrei
Attn: Membership
1048 Lenore Ave
Columbus, Ohio 43224-3352