Quad City Parrot Head Club
supporting QC charities 
           one party at a time


Official Quad City

     Parrot Head Club



Member Name

Birth date

Member #1


Member #2

Home Phone

Work Phone

Cell Phone

Member #1

Member #2






Important -- Club announcements are made by email.  Tell us if this is a problem.

EMAIL for Member #1:

EMAIL for Member #2:

Yahoo Group – to receive timely details from club leaders and to communicate with other club members about club related topics.


Add me using the email addresses above (assumed if no choice is made)


Add me to the group using this email address: ____________________________


I’m going to join at:  http://launch.groups.yahoo.com/group/QCPH/


No thanks.  I don't care to be informed.

PARAKEETS:  (Applicable only to family memberships.  ONLY MINOR CHILDREN PLEASE.  Keets are assumed to have the last name of Member #1 unless otherwise noted.  Provide birthday, including year so appropriate children’s activities can be planned.

Child Name

Birth date









Please indicate your choice of the following three categories of membership:


Administrative – Want to come to meetings and vote on club matters.


Volunteer – Want to plan and/or help with activities.  Don’t want to vote.


Social – Only want to show up at activities (is assumed if no choice is made)

Comments, Suggestions, Questions, Skills you are willing to offer the club – _______


How did you learn about the club? ________________________________________

Annual Dues:        Single = $25           Family = $40

Date Rec’d:___________ Rec’d by:___________ Amount:________ Cash or Check#_______

Contribution is not deductible as a charitable contribution for Federal income tax purposes.


Official Quad City

     Parrot Head Club


Thank You For Your Membership!

Annual Membership Dues:        Single = $25           Family = $40

Date:________________ Amount Paid:____________ Cash or Check#____________

Make checks payable to: 

Quad CityParrot Head Club (or QCPH).

Application with Payment may be mailed to:  QCPH;

PO Box 162; Bettendorf, IA  52722

The Phine print:

The Quad City Parrot Head Club is a not-for-profit social club, not a non-profit charity.  Your dues ensure the continued operation of the club:  newsletter production, letters, notices of upcoming events, postage, banners, web site production, and includes annual dues to the National PHIP, as well as allowing donation to many of the worthwhile charities we support.  Your membership dues are not deductible as a charitable contribution for Federal income tax purposes

Each member of the Quad City Parrot Head Club is responsible for his or her own actions and behavior.  All members are expected to fully comply with all laws, and any member who breaks a law does so at their own risk and is personally liable for the consequences of those actions.  QCPH Club will not be responsible or liable for those actions. 

Being a member in the QCPH Club does not guarantee the member tickets to any Jimmy Buffett shows.  A member must remain active in the club in order to be eligible for tickets or any other club promotions.

Membership in the club does not give any member permission to use Jimmy Buffett’s name, song titles, lyrics, names of businesses, or other trademarked, copyrighted or reserved material owned by Jimmy Buffett; nor can any member use the logos of the Quad City Parrot Head Club or Parrot Heads in Paradise, Inc.


**The terms Jimmy Buffett, Margaritaville, Parrot Head(s) or Parrothead(s) are registered trademarks of Margaritaville Inc. and cannot be used without written consent. The use of the terms Parrot Head Club, Parrothead Club and PHC are also trademarked by Margaritaville Inc. and are used with permission ONLY by sanctioned charters of
Parrot Heads In Paradise,Inc.**
Powered by Wild Apricot Membership Software