JOIN TODAY

The STAFFORD CANARY FAMILY is growing!

Come and join this exciting adventure as we develop this beautiful new TYPE canary with color.

Motto: We do it right. . .  We do it together.

Membership Application

New Individual Member           I heard About SCCA from:___________________________

Renewing Member                        Former Member          Update:  Address    Phone    Fax     Email

  Jr. Breeder (16 years or under)   A current adult member must sponsor the Jr. Breeder member.

   New Family membership (for Husband & Wife members only)

Your Name:________________________________________________________________________________

Your Address:______________________________________________________________________________

City:________________________________________ State:_______  Zip:________  Country:_____________

Your Phone:____________________  Fax:____________________  E-mail:____________________________

Jr. Breeder's Name:__________________________________________________________________________

Jr. Breeders Address:_________________________________________________________________________

Jr. Breeders Phone:________________ Fax:__________________  E-mail:______________________________

Annual Individual Membership (Jan 01 - 12/31)    =    ($20.00)                            $________________

Annual Jr. Breeder Membership (01/01 - 12/31)   =    ($ 5.00)                            $________________

Annual Family Membership (01/01 - 12/31)         =    ($30.00)                            $________________

  U.S. Money Order           Check              Cash                            

Total Dues Amount in US Funds ..........................................................   $________________

Make Check/Money Orders Payable To:  SCCA

Send to:  Carl Biers, Vice President

       851 Neptune Street

              Port Charles, FL 33948

               U.S.A. 

 

 

In consideration of my participation in Stafford Canary Club of America and any and all of its events, I the undersign, intending to be legally bound, for myself, heirs, executors, and administrators, do hereby fully and finally waiver, release and hold harmless, Stafford Canary Club of America, and their respective directors, officers, employees, members, agents and assignees, from any and all responsibility, liability, claims, causes of action, injuries, judgments, or other damages of any nature whatsoever, including, but not limited to, any personal injuries I might suffer, directly or indirectly, resulting from my participation in, or travel to and from the aforesaid activity. I acknowledge that I am engaging in a aforesaid activity, and knowingly executing this release, at my insistence, and request, and that I voluntarily do so without any coercion whatsoever. Further, I agree to abide by the SCCA Bylaws. Also, it is permissible to use my name, address, and phone number in an SCAA Membership Directory circulated only to other SCAA members, as indicated by my signature:

 

 

________________________________________________________________________________

Date                                                     Signature of Adult Member

Membership Benefits