Membership Application

Membership Application

Fill out this application and submit it with the button at the end. This will take you to a page to pay your dues with a credit card using PayPal (you don't need to be a PayPal member).
Applicant Name*

First NameLast Name
Occupation
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email
example@example.com
Website url
Household Member #2

First NameLast Name
Occupation
Phone Number

Area CodePhone Number
Email
example@example.com
Membership Type
prevnext( X )
Regular
(Applicant is a US resident - $25 dues + PayPal fee of $1.50)

$26.50



Household
(Open to 2 adult members residing in the same household, both US residents - $35 dues + PayPal fee of $1.50)

$37.00



Foreign
(Applicant is NOT a US resident - $25 dues + PayPal fee of $1.50)

$26.50



Foreign Household
(Open to 2 adult members residing in the same household outside the US - $35 dues + PayPal fee of $1.50)

$37.00



Junior
(Applicant is under 18 years of age - $0 dues)

$ Free



Total

$0.00
Junior's Birthdate (if under 18 years old)*

MonthDayYear
Date
Have you ever been disciplined or suspended by the American Kennel Club, United Kennel Club or any other dog club?*

YesNo
Have you ever been cited by the SPCA, any humane society, or animal control organization?*

YesNo
Have you ever been associated with or sold dogs to a wholesale or retail canine operation (e.g. pet shop)?*

YesNo
If you answered “YES” to any of the above, please provide more details below.
How many dogs do you own and how long have you had them? Specify breeds. If you have a Pumi now, provide the dog’s call name.*
Are you a breeder?*

YesNo
If YES, how many litters have you bred from your stud dog(s) and/or your bitch(es) in the past 5 years?
What activities do you do with your dogs? Check all that apply.*

Conformation (breed ring)JudgingHerdingTrackingObedienceRallyAgilityOther
How many dog events do you attend each year? Be sure to include seminars.
List any other dog clubs of which you are a member, the city/state, and any positions held.
Would you like to share some special thoughts about you and your dog(s) to help us get to know you better?
Do you have any skills or experience in any of the following areas? Check all boxes that apply.

NewsletterElectronic mediaPublic awarenessEducationMembershipAwards/TrophiesLegislative issuesEthicsRescueAgilityObedience/RallyPumi HealthOther
Do you have any other skills that you can contribute to the club’s activities?
List names of two HPCA members who are sponsoring your application.*
I (We) agree to abide by the Hungarian Pumi Club of America Constitution and Bylaws, the Code of Ethics of the HCPA and the Rules and Regulations of the American Kennel Club. A member will be refused or suspended if not in good standing with the American Kennel Club, and/or their respective country’s Kennel Club, or if found to have acted contrary to the best interests of the breed.Please indicate authorization to activate email communication, or to elect to receive only hard copy notifications via the US Postal Service. Such authorization is revocable. The Club is released from any liability should notifications be received late or not received by a member or board member due to circumstances beyond the Club’s control.*

I will accept notifications by e-mail – please list email address above.I do not wish to receive notifications by e-mail.
Applicant Signature*

Clear
Co-Applicant Signature

Clear
Should be Empty: