IYBC Registration

Thursday, May 17, 2012

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Contacts

IYBC Committee

Chad Williams, Chair

Marvin McNew

Membership

Up to 11	Fledglings
Ages 12 – 18	Students
Ages 19 - up	Mentors/ Sponsors
	Print form to join!
	Join Online

IYBC Registration Information

Thank you for your interested in the Indiana Young Birders Club (IYBC). To register a Young Birder or Fledgling please fill out the form below.

Payment

Payment can be made by PayPal or Check.

Sponsor Information

A sponsor can be a parent, guardian, or other adult.

Questions?

Please contact Sally Routh (sallydrouth@gmail.com) or Chad Williams (iybc@indianaaudubon.org).

Register

Today's Date:

Select Date

Sponsor's First Name:

Sponsor's Last Name:

Email Address:

Street:

Unit:

City:

Country:

State:

Postal Code:

Telephone:

Cellular Phone:

I would like to obtain the following memberships:

Fledgling
Young Birder

Fledgling Registration

Please enter the number of Fledglings you would like to register.

Ages: Up to 11 years old
Cost: $5 each

How many Fledglings would you like to register? (1-4):

Fledgling 1 Full Name:

Fledgling 2 Full Name:

Fledgling 3 Full Name:

Fledgling 4 Full Name:

Young Birder Registration

Please enter the number of Young Birders you would like to register.

Ages: 12 and up (must be a full-time student)
Cost: $20 each (per year)

How many Young Birders would you like to register? (1-4):

Young Birder 1 Full Name:

Young Birder 2 Full Name:

Young Birder 3 Full Name:

Young Birder 4 Full Name:

Your total comes to $:

Payment Method:

PayPal
Mail Check

Submit

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