NCA Membership Application

For Membership and/or Band Orders, fill in with your information and then mail to:

Jose Zelada
20 N. Goodwin Ave.
Elmsford, NY  10523

Club affiliations, enter show date where requested, use member name for Club Name

Check one:       [  ]  New Member          [  ]  Renewal          [  ]  Club Affiliation

Please print or type:                                                 For club affiliations, please 
                                                                                            enter show date:
Today's Date: ____________________       Show Date:___________________     

Member Name:

______________________________________________________________
Member Name: (if dual membership) :

_______________________________________________________________

Address Line 1: _______________________________________________________________

Address  Line 2: ________________________________________________________________

City / ST / Zip: ________________________________________________________________

Phone:  __________________________________________________________

Email:____________________________ @ _____________________________

List the Cage Bird Clubs in your area which you are most active (if any):

________________________________________________________________

________________________________________________________________

Please List the Colors / Mutations you breed:

________________________________________________________________

Dues:  (due annually each calendar year)
Single       $25.00              Dual   $30.00
Club Affiliation (this includes medallions for the exhibition)   
     $75.00 for 2 divisions, $100 for 3 divisions
Be sure to include $9.50 for shipping of exhibition awards.  
Enter Club information as Name and Address above.

Bands:  Bands are $.30 cents each, available in quantities of 25 (50, 75, 100, 125, 150, 175, 200).    
                Add $2.50 for shipping for each order