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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

Your ALT-Text here New Individual Member           Your ALT-Text here I heard About SCCA from:___________________________

Your ALT-Text here Renewing Member                    Your ALT-Text here     Former Member          Your ALT-Text here Update:  Address    Phone    Fax     Email

Your ALT-Text here   Jr. Breeder (16 years or under)   A current adult member must sponsor the Jr. Breeder member.

Your ALT-Text here    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)       [ ]       $__________       
 
                                        Total Due for Membership     $_________                                                                                
 
Leg Bands & Button Order Form
Prices Subject to Change Due To Cost
SCCA Leg Bands: String of 25 Only
 
[ ]  25/$10.00     [ ]  50/$20.00      [ ]  75/$30.00      [ ] 100/$40.00             $___________
                                                                          Add $2.00 S/H              $___________
[ ] SCCA Button  $5.00 Each                                   Add $2.00 S/H              $___________
[ ] US Money Order                [ ] Check               [ ]  Cash
 
TOTAL AMOUNT ENCLOSED IN US FUNDS (Make Check Payable to SCCA)    $___________
 
 
Send to:  Carl Biers, Vice President
       851 Neptune Street
              Port Charlotte, 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 undersigned, 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