DPCA Chapter Club Renewal

DPCA Chapter Club Renewal

This form MUST be filled out completely
DecYear
JanYear
Chapter Club Name
Email of club member to receive renewal verification
example@example.com
Employer/Tax ID number
Every club is REQUIRED to file with the IRS each year.
Date of last filed 990,990EZ or 990N

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Do you have an electronic copy/screen shot of your IRS filing information to upload?
Upload copy of 990, 990EZ, or 990N form

copy of the online filing receipt or a screenshot is acceptable
Cancelof
Club Mailing Address or Address of Secretary

Street Address

Street Address Line 2

CityState

Zip Code

Has there been any change in your club’s purpose, character, or method of operation?
Please explain the change in your club’s purpose, character, or method of operation.

Last WAE Held, date
Last Specialty Held, date
Last Educational Event Held, date

All Chapter Club officers and delegates MUST be a DPCA member or have applied for DPCA membership within 30 days of election.

Please make sure your officers and delgate renew their DPCA dues for {janYear}!

Officer Information

Rows	Name	Email	Phone	Date Elected	For Year Of	DPCA Member
President
VP
Treasurer
Secretary
Delegate

What date were the officers/delegate elected?
For what year(s) were the officers/delegate elected?
President Information
Is the President a DPCA Member?
President's name (DPCA Member)
President's name (non member)
President's email (non member)
example@example.com

Vice President Information
Is the Vice President a DPCA Member?
Vice President's name (DPCA Member)
Vice President's name (non member)
Vice President's email (non member)
example@example.com

Treasurer Information
Is the Treasurer a DPCA Member?
Treasurer's name (DPCA Member)
Treasurer's name (non member)
Treasurer's email (non member)
example@example.com

Secretary Information
Is the Secretary a DPCA Member?
Secretary's name (DPCA Member)
Secretary's name (non member)
Secretary's email (non member)
example@example.com

Delegate Information
Is the Delegate a DPCA Member?
Delegate's name (DPCA Member)
Delegate's name (non member)
Delegate's email (non member)
example@example.com

Dues

Amount Due

Rows	Amount Due
Annual dues
Health/Research
Rescue
Judges Education
Juniors
General Fund
Other

Total Amount Due

In as much as our parent organization, Doberman Pinscher Club of America, has included us in a 501(c)(3) group exemption recognition before the IRS,we acknowledge our responsibility to make annual information reports pertaining to our continued good standing. We further agree to adhere to their specific policies related to the 501(c)(3) status which in their judgment keep this status well maintained. While we reserve the right to challenge any such policy that may be established, we will inform them of such action in writing 30 days prior to any implementation on our part.

Dues are payable upon receipt of notice.

Membership will be automatically terminated if dues are not received by January 31, {janYear}.

Dues must be received by December 31, {number} for member club to be eligible to participate in any parent club business conducted in January {janYear}.

Pay for Chapter Club Renewal

USDDescription

Payment Method
Credit	Express

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty: