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Cecil Bird Club   A Chapter of the Maryland Ornithological Society   Promoting birding in northeastern Maryland

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Membership Application

The membership year begins on September 1, but new memberships are accepted at any time.  Those who join later than March 1 should remit half the dues shown below.  Please print this page, fill in the requested information, and mail the completed form with your dues to the Treasurer, Pat Valdata, 36 Gina Court, Elkton, MD 21921. Please make checks payable to the Cecil Bird Club.

Name(s)

__________________________________________________________________________

Address

__________________________________________________________________________

City

__________________________________________________________________________

State

___________________________

Zip

____________

Telephone

__________________________________________________________________________

E-mail

__________________________________________________________________________

May we publish the information above in the CBC and MOS membership directory? (circle one)

Yes

No

 New Member ____ or Renewal ____

 Choose one of the following categories and remit the dues as shown:

______	Individual	$30 (includes $20 for MOS)
______	Household	$40 (includes $30 for MOS)
______	Sustaining	$75 (includes $50 for MOS)
______	Junior	$10 (includes $5 for MOS)
______	Affiliate	$15 (for members of other MOS chapters) Indicate other chapter_________________
______	Life	$900 (includes $1000 for MOS, payable in 4 annual installments of $225)

Thanks for joining us!

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last updated  08/31/10