G.O.C.B.S. Membership
Application Form

Membership fees are as follows:

                             January-December                    July-December 1/2 Price
Junior (under 16)       $ 7.50/year
(no voting privileges)           $3.75
Single                       $15.00/year                                 $7.50
Family                      $20.00/year                                 $10.00
Business Associate     $20.00/year                                 $10.00

Meetings are at 3:00 p.m. on the 3rd Sunday of each month at the
Nebraska Humane Society 8929 Fort Street.

MAKE CHECKS PAYABLE TO G.O.C.B.S.

Please fill out the following information:

Date:  ________________________New membership:  __________ Renewal membership:  __________

Name(s):  ________________________________________________________________________________
Address:  ________________________________________________________________________________
__________________________________________________________________________________________
                                        (DON'T FORGET ZIP CODE)

Birth Date: Month/Day
(only)_______________________________________________(list all names from above)

Home phone:  ______________________(_____roster or _____unlisted)
Work phone:  ______________________(_____roster or _____unlisted)

e-mail address:  _________________________________________________(included or unlisted?)

Pet birds: _______________________________________________________________________________
__________________________________________________________________________________________

Birds you breed:  ________________________________________________________________________
__________________________________________________________________________________________

Please bring this to one of the meetings or mail to:
                            GOCBS
                            c/o Elsa Ashelford
                            1641 Manatt Street   
                            Lincoln, NE 68521


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