Parrotheads of the Blue Ridge


 You know you want to join the PHLOCK!!!!!
PHBR Membership Application 2019

The Parrot Heads of the Blue Ridge is acting as a non-profit social organization whose purpose is to bring together people who share the common interests of listening to Jimmy Buffet, and similar music, bettering the community in which we live, and socializing at local events.

Parrot Heads of The Blue Ridge membership is open to all who wish to join regardless of gender, race, creed, age, religious belief or disability. Members must share a common interest in the PHBR purpose as noted above.
Annual Membership: 
-    Single: $25.00

The classes of PHBR memberships are:
a) Single Membership: Persons 18 years of age and older.
b) Keet: Persons under 18 years of age who are relatives of an individual or couple member. Keets do not have the right to vote or hold office.
c) Membership fees are based on a standard calendar year from January 1st to December 31st of each year

Member Information
Date     MM/DD/YYYY
First Name:
Last Name:
Date of Birth:      MM/DD/YYYY
Address Street 1: *
Address Street 2:
City: *
Zip Code: * (5 digits)
State: *
Home Phone:      XXX-XXX-XXXX
Mobile Phone:     XXX-XXX-XXXX
Email address:
Co-Member Information
First Name:
Last Name:
Date of Birth:       MM/DD/YYYY
Home Phone:    XXX-XXX-XXXX
Mobile Phone:     XXX-XXX-XXXX
Email address
 Keet Names, Age
Select type of Membership:   
Phlock sponsor:
Other Information

Payment Options: 
Print the application or submit it electronically.
1.  Pay by check or cash at any social or membership meeting.
2.  Mail payment to P.O. Box 21511, Roanoke, VA 24018
3.  Pay online by credit card. PayPal account is not required when paying by credit card. 
 Single Membership $25                              

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