Phu Quoc Ridgeback Association Membership Form

Phu Quoc Ridgeback Association

Digital Membership Form
By submitting this form, the applicant agrees to abide by the Club’s constitution, bylaws, rules, regulations, code of ethics, and accept the PQRA Board of Directors’ jurisdiction in the above. All of the important documents can be found on the PQRA official website.
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
E-mail *
example@example.com
If you are applying as a household, please add additional member names and relevant address and contact information. Please include whether each member is applying as a Breeder, Owner, Exhibitor, or Judge.

Household Additional Members, if applicable

	Full Name	Address	Contact Number	Status
1
2
3

Additional Information
Kennel Name
if applicable, skip if not
Briefly describe your experience with the breed, including but not limited to how many years you have owned the breed and activities you are involved in with the breed *
Do you own at least one Phu Quoc Ridgeback that you would like to register with the club or own at least one Phu Quoc Ridgeback that is already registered with the club? *

Yes, I own (a) PQR(s) that is already registered with the club Yes, I own (a) PQR(s) that I would like to register with the club No, I own a PQR mix No, I do not own a PQR or PQR mix Other
Please check the designation that applies to you *

Breeder - you have had and have registered a litter within the last 3 years Exhibitor - you have handled a dog at an event (show, sporting or other) in the last 2 years Dog Owner - you own a registered dog and are active with the club Other
Submission (via PayPal to vpqrca@gmail.com) *

I have sent the $20 USD individual membership fee to the PQRA I have sent the $50 USD household/family membership fee to the PQRA
Are you over 18 years old? *

Yes No, I am applying for a Junior Membership
I understand that this application will hereby apply me for membership with the PQRA upon submission and that I agree to the club’s Constitution, Bylaws, and Code of Ethics. *

I agree
Parties involved agree that this agreement may be electronically signed and that the signature here is the same as a handwritten signature for the purpose of validity, enforceability and admissability.

If you do not wish to apply and sign digitally, you may download, print, sign and scan a paper copy of the membership form to be sent to vpqrca@gmail.com instead.
Signature

Clear
Date

Month Day Year
Date
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform