Member Online Application

First Name:

Last Name:

Address:

City:

State:
Zip:

Primary Email

Family Memberships. Add 2nd email address:

Phone:

Permit Number if Held:

What banding stations are you affiliated with?

How did you hear about us?

TYPE OF MEMBERSHIP (Check appropriate box for Membership Classification)

Active Member - $35 per year. A regular dues paying memberHousehold Member- $40 per year. A two-person membership (member plus one person – either a spouse, child or parent who shares the same residence).Institutional Member - $45 per year. A membership for an institution (university, library, museum, educational banding stations, etc)Life Member - $500 one time payment. A lifetime membership; can also be made in four successive payments of $125 eachStudent Member - $20 per year. For students enrolled in full-time academic programsNon-Subscribing Member - $5 per year. A special membership category for active members of either the Western Bird banding Association or the Inland Bird Banding Association only

ADDITIONAL FEE FOR NON-US RESIDENTS

If you reside in Canada – add $10 to the above prices to cover additional postage costsIf you Reside in Another Country other than Canada – add $26.50 to the above prices to cover additional postage costs

METHOD OF PAYMENT FOR MEMBERSHIP

I will pay by credit card on-lineI will mail a check