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Piedmont Bird Club Membership Form – Individual or Family Membership
If you are a full-time student,
click here
to go to the form to register for a free Student Membership
Please Note: Items marked with a
*
are required.
*
Indicates required field
Name
*
First
Last
Additional names to list on the membership (family membership only)
Spouse or other adult household member (if applicable)
*
Children (if applicable and if you would like them included in the membership)
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
2nd Phone (optional)
*
2nd Email (optional)
*
Please select one
*
New membership
Renewing membership
Membership Type
*
Individual ($15/year)
Family ($20/year)
Birding level
*
beginner
intermediate
experienced
If you are a new member, how did you hear about PBC?
*
web site
newspaper
PBC brochure
friend
other
If you selected "PBC brochure" above, where did you get the brochure?
*
Payment Options
PBC offers two methods to pay your annual dues:
You can complete the process securely online using a credit/debit card or a PayPal account.
You can mail a check to our Post Office box.
How will you pay your membership dues?
*
Online
Mail a check
Click the button below to proceed to the page with instructions for paying online or by mail.
Submit
