CBC Participant Address Form

Note: If you filled out a form last year AND your information hasn’t changed, you
don’t need to fill out a form again this year.

Simply click the gray boxes, type in the information, save the form and send it back to
me as an e-mail attachment to alan.knothe@myfwc.com.

Name:

Street Address:

City: State: Zip:

e-mail:

Phone #:

Would you like to receive the Christmas Bird Count issue of North American Birds (there
is no additional charge for this magazine)?
Yes or No

Please indicate your preference for a territory to survey (see the map on the next page to
match a territory with a number. Rank your choices in order of preference. People that
helped with last year’s count will be given preference. After that, it will be first come first
serve.
Territory Leader 1st Choice 2nd Choice 3rd Choice
1. The Bay and Alan Knothe 1st Choice 2nd Choice 3rd Choice
Gulf
2. St. Vincent Barbara 1st Choice 2nd Choice 3rd Choice
Island North Stedman
3. St. Vincent Brad Smith 1st Choice 2nd Choice 3rd Choice
Island South
4. The Miles Bob Henderson 1st Choice 2nd Choice 3rd Choice

5. Box-R Marvin Collins 1st Choice 2nd Choice 3rd Choice

6. Apalachicola John Murphy 1st Choice 2nd Choice 3rd Choice

7. Little St. Seth Blitch 1st Choice 2nd Choice 3rd Choice
George Island

Map on next page