Des Moines Parrot Head Club

Application for Enjoyment

 

 

This club is founded as a non-profit social club involved in the support of local charities www.desmoinesparrotheads.com

 

 

APPLICANT 1

 

Name            _____________________________________________________

 

Address        _____________________________________________________

 

City/State    _____________________________Zip______________________

 

Home Phone/Mobile_____________/_____________Birthdate_______________

 

Email           _____________________________________________________

 

         

          APPLICANT 2

         

          Name           _____________________________________________________

 

          Email            ____________________________   Birthdate_________________

 

          Relationship to Applicant 1  __________________________________________

 

          Phone Number/Mobile:  ____________________________________________

 

          ADDITIONAL APPLICANT(S)

         

          Name           _____________________________________________________

 

          Email            ____________________________   Birthdate ________________

 

          Name           _____________________________________________________

 

          Email           _____________________________ Birthdate _______________

 

          Relationship to Applicant 1  __________________________________________

NOW FOR THE PHUN STUFF…

 

Please circle or fill in your response.

 

1.  Do you like to have fun?                                             YES                             NO

                       

     If you answered NO to question number 1, do not proceed with application.

 

2.  What is your favorite alcoholic beverage?                     __________________________________

           

3.  What is your favorite non-alcoholic beverage?  __________________________________

 

4.  Have you been to a Jimmy Buffett concert?                 YES                             NO

 

5.  What is your favorite Jimmy Buffett song?                   __________________________________

 

6.  How did you find out about the Des Moines Parrot Head Club?   __________________________

 

________________________________________________________________________________

 

7.  How did you discover Jimmy Buffett?  _______________________________________________

 

________________________________________________________________________________

 

________________________________________________________________________________

           

8.       Describe any talents, qualities, or hobbies you have that you feel may be an asset to the club.

 

________________________________________________________________________________

 

________________________________________________________________________________

 

________________________________________________________________________________

 

 

Please sign and date this application

 

Applicant 1        _______________________________________  Date ______________________

 

Applicant 2        _______________________________________  Date ______________________

 

By my signature above, I understand that the Des Moines PHC and PHIP, Inc. are recognized by but in no way attached to Jimmy Buffett and his business interests in Key West, New Orleans, Charleston, and Orlando.  They are not associated with HK Management, MCA Records, Island Records, or Margaritaville Records.  By my signature I recognize and comply  that Mr. Buffett's name, his song titles, lyrics, names of businesses owned by Mr. Buffett, and the term "Parrot Head" are all registered trademarks and should not be used for the pursuit of profit. Clubs are allowed to use the term "Parrot Head" on t-shirts, etc., but NOT Jimmy Buffett's name. By filling out and signing this application, I accept that the Des Moines Parrot Head Club, it’s officers, or any of the members are not responsible for my behavior. 

 

 

Annual dues are $12 per single membership. 

 

Please mail this application with your check to:

 

Des Moines Parrot Head Club

4285 NE 34th St

Des Moines, IA 50317