Wildlife Rehabilitators of North Carolina
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Membership Application
*First Name:
*Last Name:
*Address:
Address2:
*City:
*State:
NC
SC
VA
*Zip Code:
Affiliation:
*E-mail:
*County:
**
Home Phone:
**
Work Phone:
**
Cell Phone:
List in Directory:
Yes
No
Allow Public View:
Yes
No
Category:
Individual
Family
Permits Held:
No
Yes
Sub
State Permit
No
Yes
Fawn Permit
No
Yes
Sub
Federal
Permit
No
Yes
Falconry Permit
No
Yes
Sub
Education Permit
Rehab Categories:
Small Mammals
All
Babies
Adults
Mid Mammals
All
Babies
Adults
Reptiles
Venomous Snakes
You must have a federal permit or be a subpermittee on someone else's permit to be listed as accepting birds.
You will be allowed to list a group below only if you are designated as being covered by a federal permit.
Songbirds
Seabirds
Raptors
Wading Birds
Waterfowl
2nd member of a family membership
First Name:
Last Name:
Membership is $15. To join or renew your membership submit this form, then send your $15 check to:
WRNC, 2542 Weymoth Rd, Winston-Salem, NC 27103.
* Required
items,
**
One phone number is required
Wildlife Rehabilitators of North Carolina
