Sponsorship Enrollment Form

Chicken, A Festive Amazon, 1970-1998Chicken
A Festive Amazon
Sponsorship Form

Our Sponsorship Program is dedicated to the memory of “Chicken,” a Festive Amazon. Chicken was adopted by Layne David Dicker and Sally Spencer. Chicken succumbed to lung cancer in his twenty-eighth year of life. He was much loved and greatly missed.

For more information, call PEAC at (619) 287-8200
Print this page, fill-in the blanks, and return it with your check or credit card information to:
Parrot Education & Adoption Center
P.O. Box 600423
San Diego, CA 92160
Full Name:
Mailing Address:
City, State, ZIP, Country:
Phone and e-mail:
Credit card type: [  ] VISA       [  ] Mastercard  [  ] Discover   [  ] American Express
Credit card number:
Expiration date (MM/YYYY) & CVV (located on the back of your card):Signature:
Sponsorship type:


[  ] $50.00 Macaw, Large Cockatoo
[  ] $25.00 African Grey, Amazon
[  ] $15.00 Mini Macaw, Eclectus
[  ] $10.00 Conures, other small species
[  ] I wish to remain anonymous. Do not print my name on the Sponsorship List
[  ] I am unable to give a monthly donation, but would like to help with a one time donation of: $ ____________________

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