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The information will NOT be published without your permission.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