Baillie Birdathon Registration Form
Dr. Mr. Mrs. Ms. Miss
First name:
 Last name:
Address:
City:
 Prov.
Country:
 Postal code:
Email:
Phone (home):
 Phone (work):

I prefer to access the Birdathon online participant kit (otherwise a kit will be mail to new participants)

All Birdathon participants receive an official Baillie Birdathon t-shirt.
I want to donate the cost of my Birdathon t-shirt ($20 per shirt). After you submit this form, you can either pay using a credit card on our secure website or print a form and pay by mail, fax or phone.
Amount of your donation $

T-shirt size: small medium large extra large do no send t-shirt
Note: If you register as a couple and need a second t-shirt, please include a short note in the comments box below, indicating the size of the second t-shirt.

I qualify as a young Birdathoner, I am under 19 years of age

I want to direct some of the money I raised to another conservation organization.
I understand that my name and address may be shared with my designated organization.
My club's information is:
    Club/Organization Name:
    Address:
    City: Prov.
    Postal Code:     President/Exec. Director:

Comments:

From time to time, BSC may send information regarding our programs, special issues, membership, and other correspondence. If you would prefer not to receive this information, please contact us by e-mail at rkirton@bsc-eoc.org. BSC does not sell, trade or exchange mailing lists. Thank you.


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