Phu Quoc Ridgeback Association 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 NameLast Name

Address*

Street Address

Street Address Line 2

CityState / 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 clubYes, I own (a) PQR(s) that I would like to register with the clubNo, I own a PQR mixNo, I do not own a PQR or PQR mixOther

Please check the designation that applies to you*

Breeder - you have had and have registered a litter within the last 3 yearsExhibitor - you have handled a dog at an event (show, sporting or other) in the last 2 yearsDog Owner - you own a registered dog and are active with the clubOther

Submission (via PayPal to vpqrca@gmail.com)*

I have sent the $20 USD individual membership fee to the PQRAI have sent the $50 USD household/family membership fee to the PQRA

Are you over 18 years old?*

YesNo, 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

Date