Coosa Landsharks Parrot Head Club

Membership Form

Are you interested in joining the Coosa Landsharks Parrothead Club?  Fill out the information so that we can get the process started!

Single Membership $24
Family Membership $36

How did you hear about the club?:

First Name:
Last Name:
Phone Number:
Email Address:
Phone Number:
  Hosting Parties
  Writing for Newsletter
  Producing Newsletter
  National Community Service
  Local Community Service
  Outdoor Activities
  Weekend Trips
  : Other  
Are you a human?*  

Coosa Landsharks Parrot Head Club

P.O. Box 8603

Gadsden AL  35902

Membership Application

Single $24/Family $36




Home Phone:_________________________________Work Phone:______________________________________

E-Mail Address:_________________________________________Fax:___________________________________


I am interested in the following activities:

__Parties __Writing for Newsletter __Producing Newsletter __Hosting Parties

__Local Community Service__National Community Service__Club Promotion

__Concerts__Weekend Trips__Outdoors Activities


How did you hear about the club?______________________________________


The Obligatory Fine Print:

Each member of the Coosa Landsharks Parrot Head Club is responsible for his or her own actions and behavior and shall treat phellow members, guests and hosts and their personal property, with respect.  Members agree to abide by all local, state and federal laws.  Members agree to abide by all the Bylaws of the Coosa Landsharks Parrot Head Club.

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

Since Parrot Heads are known to enjoy a cold one, we support using a designated driver.  This contribution is not tax deductible as a charitable contribution for federal or state income tax purposes.