2012 Residency App

St MinneSomePlace In Paradise

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2012 Residency App

Residency Application

2012 RESIDENCY APPLICATION

To claim your lone palm on the island of St. MinneSomePlace and reside among the many other crazy Parrots Heads on our quaint island, please complete the residency application below. For your convenience, there are three types of annual memberships: Adm, Active and Social.....see descriptions below. So decide how involved you want to be and join us down island!

St MinneSomePlace membership is $25 dollars for individuals
and $35 dollars per year for couples.

Memberships are for the calendar year.

After submitting this form you will be contacted confirming your residency.
Checks can be made out to St. MinneSomePlace and mailed to:

St MinneSomePlace

PO Box 1201

Maple Grove, MN 55311

Payment can be made by PayPal...see instructions below.

You may download and print the form:
Download and Print Blank Form

2012 Residency Application

If applying for more than one person, please select each person's membership preference, either Adm, Active, or Social.

NOTE: Your application will be routed to Membership. You will receive a confirmation email shortly. If you chose to pay by PayPal, please return to the bottom of this page and follow the PayPal procedure.

In case you are wondering, this payment is not tax deductible as a charitable contribution for federal tax purposes. All other donations are tax deductible, as this funding is dedicated to community service efforts rather than operational expense of our organization.

DATE: *
Membership (1): *
Membership (2): *
First Name(1): *
Last Name(1): *
First Name (2):
Last Name (2):
Address Street: *
City: *
State: *
Zip Code: *	(5 digits)
Daytime Phone: *
Evening Phone: *
Email, Personal: *
Email, Business:
Email, Additional::
Permission to Share Email:
Occupation/Company:
Birthdate (MM/DD):
Age Group: *
Children, Ages:
How did you hear about St MSP:
What is your favorite Buffetism (saying, song, lyric, etc.):
Personal Interests and Hobbies:
What is your favorite Buffett/Parrot Head experience:
Payment: *

If you have any questions regarding this procedure, please contact HeadBwana