Bluebird Society of PA  
Membership Form






Regular/Family (16-64yrs)        Senior (65+)                   Organization/Corporate         Lifetime
1 year- $15                                1 year- $12                1 year- $100                                      $375
3 years- $40                                3 years- $30      3 years- $275                        


*When you Renew for 3 years, you can take advantage of our discounted rates shown above! 
* See the BSP website for Junior Membership opportunities.


Mail to:
Bluebird Society of PA
P.O. Box 12
Exton, PA 19341


_____ New Member        _____ Renewal                _____ Donation


Name:  ______________________________________________________________________________________________


Address:  ___________________________________________________________________________________________


City: ________________________________________________________________________________________________


State:  _____________________________Zip: ________________________County: ___________________________


Phone: _____________________________________________________________(required in case newsletter is undeliverable) 


Email: ______________________________________________ (required if questions or emailed delivery of Newsletter)

Donation (optional): $___________________


Total Amount Enclosed: $ ______________________


If you are a new member, have you received your new membership packet? 
_____ Yes   _____ No


How would you like to receive your newsletter?
_____ Regular mail     _____ Email


I would like to help with:
______ County Coordinator                ______ Nestbox Monitoring
______ Nestbox Construction                ______ Newsletter
______ Photography                        ______ Research
______ Speakers’ Bureau                ______ Fundraising
______ Farm Show (Jan)                ______ BSP Conference (April)        
______ Garden Expo (Mar)                ______ Ned Smith Day (July) 




OFFICIAL USE ONLY:   Check # ____________        Renewal year ____________