Wildlife Rehabilitators of North Carolina
Home
Membership Application
*First Name:
*Last Name:
*Address:
Address2:
*City:
*State:
NC
SC
TN
VA
*Zip Code:
Affiliation:
*E-mail:
*County:
i.e. Wake, Guilford
**
Home Phone:
**
Work Phone:
**
Cell Phone:
Do you want to be in the directory for members:
Yes
No
Do you want the public to have access to your information?:
No I do not want to be on the public list
Yes I want to be on the public list
Yes means you will show on the membership list seen by the public when they are looking for a rehabilitator. No means you will not be shown on the public list.
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 Species Categories:
Squirrels
Mid-sized Mammals
Rabbits
Reptiles
Opossums
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:
After filling out this form, click on the 'Submit' button below to continue with registration for the symposium on the CE Office site.
* Required
items,
**
One phone number is required
Wildlife Rehabilitators of North Carolina