Membership Renewal Form 2021

Movers and Shakers PWD Club of the Carolinas

2023 Membership Renewal/ Application
MEMBERSHIP REGULATIONS:

All dues are due January 1. If dues are not paid by that date, you will not be eligible to vote or for club benefits until membership payment is received.
In order to be eligible for Club awards, dues must be received by April 1. Memberships received after that date must include a $5.00 late fee.
As of August 1 dues will be considered lapsed and all applicants must re-apply (two sponsors required) in January 2023. Club memberships are renewed annually.
There are four membership categories: Individual (or first household member); additional family member in same household as individual Family members; Associate and Junior. Please complete the information for your preferred membership categories below.
Are you currently a Movers and Shakers PWD Club member in good standing?

YesNo - I am applying for membership
If you are applying for a new membership, have you acquired your first PWD in the last 12 months?

YesNo
If you are applying for a new membership please provide the names of two M&S Club Sponsors
Individual membership (Annual fee: $35.00)

(Full voting membership, eligible for office)
Name
Email address
example@example.com
Street address
Street address line 2
City
State
Please Select
Zip code
Preferred Phone Number
Preferred Phone Number (000) 000-0000
2nd Regular Membership (Annual fee: $25.00)

(Same household as 1st Active Member elegible to vote and hold office)
Full Name
Email
example@example.com
Phone Number
Preferred Phone Number
Associate Membership (Annual Fee $25.00)

(Outside of geographic region or second household member, no vote, no office)

Movers and Shakers is offering a Complimentary Membership to owners who have acquired their first PWD within the last 12 months.
Name
Email address
example@example.com
Street address
Street address line 2
City
State
Please Select
Zip code
Preferred Phone Number
Preferred phone number (000) 000-0000
Junior membership ($10.00)

(Under 18, no vote, no office)
Name
Email address
example@example.com
Street address
Street address line 2
City
State
Zip code
Preferred Phone Number
(000) 000-0000
Are you a member of the PWDCA?

YesNo
What is your Kennel name? (for breeders only)
Kennel Name
List any other memberships in PWD regional or local clubs
Portuguese Water Dogs Currently Owned

For each dog owned add Registered Name, Call Name, age and titles as you wish them displayed in the membership directory
What activities would you like to see the club sponsor this year?

Obedience ClassesTrackingAgilityConformationWater TrialsWater Work Training DaysFun DaysClub Get-togethersFast CatOther
By processing this application for membership all persons named agree to the following:
- that they will abide by the Movers & Shakers Constitution and By-Laws;
- that they will abide by the rules of the American Kennel Club;
- that they are not the subject of disciplinary proceedings or have been suspended or expelled from the AKC;
- that they are not under investigation, charged or convicted of any crime involving cruelty to animals by any local, state, or federal authority.
First Regular Member, Associate or Junior Member Signature

Clear
Additional Household Member Signature

Clear
If you prefer to send by snail mail, download and print the the PDF version here and enclose with a check for Membership(s) and Trophy Donation TO: Movers and Shakers PWDC and RETURN TO:

Kim Kluckman, M&S Membership

422 N Serenity Hill Cir, Chapel Hill NC 27516

Form can also be e-mailed to mail@moversandshakers.org
Membership Dues (Check Your Membership Category and Please Donate to the Trophy FUND!)
prevnext( X )
Individual membership (one person only)
$35.00



Individual plus another household member
$60.00



New PWD Owner Associate MembershipComplimentary membership for an owner who has acquired their first PWD in the past 12 months. Please check the box on left and skip to the Submit Button at the bottom of the form.
$ Free



Associate Membership
$25.00



Junior membership
$10.00



Donation to Trophy Fund (Select Quantity by $10.00 increments)
$10.00 Quantity
Item subtotal:$0.00



Total

$0.00
loading smart payment buttons...

The payment is ready! It will be completed once you submit the form.
Should be Empty:

Portuguese Water Dogs Currently Owned