Your Name _______________________________________________________________________

Your Address _____________________________________________________________________

Your City ________________________________________________________________________

Your State _______________________________________________________________________

Your Zipcode _____________________________________________________________________

Kind of Feeder (Ground,Tree,Pole) _____________________________________________________

Brand of Bird Seed Used _____________________________________________________________

Species You Attract _________________________________________________________________

Species You Attract _________________________________________________________________

Species You Attract _________________________________________________________________

E-Mail Address _____________________________________________________________________

Web Site Address ___________________________________________________________________



Please Print, Fill Out and Return This Form Along With the $1.00 Monthly Registration Fee or
Along With the $12.00 Yearly Registration Fee or
A Life Time Registration Fee in the Amount of $250.00 To:

BLUEBERRY HILL TRUST
Bird Feeder Registration Form
212 Blueberry Hill Road
Harwinton,Ct. 06791-3019.

Thank You!
E-Mail: Blueberryhilltrust@yahoo.com