International Conure Association

NAME:________________________________________ E-Mail:__________________________________

ADDRESS:__________________________ CITY:_______________ STATE:_______ ZIP:________

PHONE:_________________________________________ FAX:_______________________________________

Do you keep Conures as: Pets______ Breeders______

Both______
May we include info in a published membership roster? Yes______ No_____
May we list the types of Conures (NO NUMBERS)? Yes______ No_____
Would you like referrals for info?  Yes______ No_____
Would you like referrals for  Birds? Yes______ No_____
Are you interested in participating in a stud book? Yes______ No_____

Please fill out this survey. The information will NOT be published without your permission.

Species Pair Prov x-m x-f Pet/U Species Pair Prov x-m x-f Pet/U
Sun           Red Fronted          
Jenday           Cactus          
Gold Capped           Maroon Bellied          
Golden           Green Cheeked          
Peach Fronted           Souance's          
Half Moon           Black Capped          
St. Thomas           Pearlie          
Brown Throated           White Eared          
Dusky Headed           Painted          
Blue Crowned           Crimson Bellied          
Green           Patagonian          
Red Throated           Nandy          
Finsche's           Austral          
White Eyed           Slenderbilled          
Red Masked           Yellowsided          
Mitred           Fallow Gr. Cheek          
Hispanolian           Blue Throated          
Olive Throated           Other          

DUES- INDIVIDUAL $20.00______ FAMILY $30.00______ JUNIOR $15.00______ INTERNATIONAL ADD $5.00______

MAKE CHECKS PAYABLE TO: INTERNATIONAL CONURE ASSOCIATION
SEND TO : ICA PO BOX 70123 Las Vegas , NV 89170