Virtual Parrot Head Club
Membership Registration/Renewal Form

Use this form if you are:
Signing up a new/expired Membership
or
Renewing an active Membership

IMPORTANT: PLEASE READ!

If you already have registered with the VPHC Forum Please use the same User Name and Password here.

Please fill in all areas marked with an *
You do not have to give your phone number but there must be some numbers in that field.

You will receive an email Account Renewal Notice exactly 30 days prior to your renewal due date. Keep your email address up to date.

TERMS AND CONDITIONS

If payment is not received within thirty (30) days of the application submission, the application will be unapproved.

Members are solely responsible for keeping their membership in good standing. Members are also solely responsible for keeping their membership information and email address up to date.

You can be removed from this membership data base by emailing your request to our Membership Director.

I agree to the Terms and Conditions above.

Choose an account type

Member Information
Fields marked with an asterisk
are required input fields.

First Name *

Last Name *

Address *

Address 2

City *

State or Province *

Postal Code (ZIP) *

Country *

Telephone Number *
Use all zeros if you want yours kept private

Valid E-Mail Address *
Note: Trying to register more than one person with the same email address isn't normally allowed by this system.
Contact webmaster@vphc.com if you are unable to obtained a separate email address.

Choose a User Name
User Name *

Choose a Password
Password*
Verify Password*

Method of Payment
Please be sure to select your payment method

Pay by check * $16

Make check payable to:
VPHC
4848 Rockwell Rd.
Rockwell, NC 28138
Please write your user name(s) on your check

PayPal * $16