CPHC On-line Membership Application

To apply for membership, please complete all questions*

Chicago ParrotHead Club Membership year runs from October 1 to September 31

Membership*: New
Renewal

Annual Renewal/Membership
Individual ($25)
Joint ($35)
PLEASE NOTE: A $0.30 + 3% processing fee will be added to the amount indicated above.

New Member - Expires: 9/31/2019 (4th Quarter Application 7/1-9/31)
Individual ($25)
Joint ($35)
PLEASE NOTE: A $0.30 + 3% processing fee will be added to the amount indicated above.

New Member - Expires: 9/31/2018 (3rd Quarter Application 4/1-6/31)
Individual ($7) - Prorated
Joint ($9) - Prorated
PLEASE NOTE: A $0.30 + 3% processing fee will be added to the amount indicated above.

New Member - Expires: 9/31/2018 (2nd Quarter Application 1/1-3/31)
Individual ($13) - Prorated
Joint ($18) - Prorated
PLEASE NOTE: A $0.30 + 3% processing fee will be added to the amount indicated above.

New Member - Expires: 9/31/2018 (1st Quarter Application 10/1-12/31)
Individual ($19) - Prorated
Joint ($27) - Prorated
PLEASE NOTE: A $0.30 + 3% processing fee will be added to the amount indicated above.

Name*: First Name:
Last Name:

Nickname:

Birthday*:

Cell Phone*:

Hm/Wk Phone:

E-mail*:

CoMember Name: First Name:
Last Name:

CoMember Nickname:

CoMember Birthday*:

CoMember Cell Phone*:

CoMember Hm/Wk Phone:

CoMember E-mail:

You will receive an email and be invited to join our Yahoo E-mail Group (this is our primary source of communication). Instructions for joining will be contained in the email.

Address*: Street Address:

Street Address Line 2:

City: State:

Zip Code: County:

By checking the boxes below you can choose whether or not to be published in the club's directory and how much information will be available.

Name Phone Email

How did you hear about us?

Favorite Buffett Song:

Favorite Buffett Lyric:

My One Particular Harbor is:

I like mine with...

What kinds of events would you like to volunteer for:
Summer Chi.ILL Event
Misericordia Events
Alzheimer's Walk
Tailgating
House Concerts-hosting
Adopt-A-Highway

Anything we forgot

Completion of this application and payment of dues is your consent to membership in this organization.

As member you agree to bylaws adopted by the membership of the Chicago Parrot Head Club as well as Parrot Heads In Paradise, Inc., and the use of the above information by the club for matters pertaining to its operation and events. Activities organized by the club are for enjoyment of the membership of the Chicago Parrot Head Club. Our officers or members are not liable for any injury, loss or damage of personal property. Each member is responsible for his or her own behavior as well as that of their children. Chicago Parrot Heads, its members and its officers will not be responsible for your actions during your association with the organization. This contribution is not deductible as a charitable contribution for Federal Income Tax purposes per PHIP bylaws. The terms Jimmy Buffett, Margaritaville, Parrot Head(s), Parrothead(s), Parrot Head Club, Parrothead Club and PHC are registered trademarks of Margaritaville Inc.

Signature (initials):

CoMember Signature (initials):

Renewal Fee Structure
Renewal payment of dues by current members will be made annually in September, being the anniversary month of CPHC.

New Member Fee Structure
New Members (per current By-Laws), joining the club after the annual renewal date (September 31) will pay a prorated amount of 75% for the first quarter rounded up, 50% for the second quarter rounded up, 25% for the third quarter rounded up, and within the fourth quarter will pay the full amount of membership up until the next years renewal date. Any member who joins CPHC under the reduced prorated rate but does not pay in full at the next scheduled annual renewal must pay the full membership amount before being considered for any Club benefits as stated within CPHC by-laws for the next calendar year.

Our Meetings are at 7:30 pm, every third Wednesday of the Month at:
HB Jones
551 S York St
Elmhurst, IL 60126

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If Payment is not completed, application will not be submitted
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Individual Renewal Membership: $26.06

Joint Renewal Membership: $36.36
6

Individual Q4 New Membership: $26.06

Joint Q4 New Membership: $36.36

Individual Q3 New Membership: $7.52

Joint Q3 New Membership: $26.06

Individual Q2 New Membership: $13.70

Joint Q2 New Membership: $18.85

Individual Q1 New Membership: $19.88

Joint Q1 New Membership: $26.06

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