Name: Mr. Mrs. Miss Address: City: State: Zip: County: Home Phone: Work Phone: Cell Phone: Email: Affiliation: List in Directory for members: Yes No Show on website for Public: Yes No Do you have a current state rehabilitation permit? YES NO (If yes, please include a copy) Do you have a current federal permit? YES NO (If yes, please include a copy) Do you have a current fawn permit? YES NO (If yes, please include a copy) Do you have a current education permit? YES NO (If yes, please include a copy) Do you have a membership in the International Wildlife Rehabilitation Council (WRNC), the National Wildlife Rehabilitators Association (NWRA), or any other state or local rehab groups? Please list them: What do you rehab: small mammals medium-sized mammals 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 raptors waterfowl seabirds wading birds MEMBERSHIP FEE $15.00 Please print this form and make your checks payable to WRNC. Mail the form, copies of your permits and the check to the address below.
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