Northwest Georgia Parrothead Club Membership Application

We are the people our parents warned us about!

25 Conns Lake Rd SE

Lindale, GA 30147

Single $25/Couple $30

Name(s): __________________________________________________________________

Address:_______________________________________________________________________________

City:_____________________________________State:______________Zip:_______________________

Home Phone:_________________Cell:_____________________Work:___________________________

E-Mail Address:_________________________________________________________________________

Birthday:_____________________________________________________________________________

Hobbies:______________________________________________________________________________

How did you hear about the club?_______________________________________________

Comments:____________________________________________________________________________

The Obligatory Fine Print:

Each member of the NWGA PHC 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 bylaws of the NWGAPHC.

Membership in the club does not give the member permission to use Jimmy Buffett’s name, song titles, lyrics, names of businesses or other trademarked, copyrighted or reserved material owned by Jimmy Buffett: nor can any member use the logo of the NWGA PHC or PHIP.

Since Parrotheads are known to enjoy a cold one, we support using a designated driver. This contribution is not tax deductable as a charitable contribution for federal or state income tax purposes.

Signature_______________________________________Date:______________________