Membership Form

Peninsula Dog Fanciers' Club, Inc.

Renewal Application
Adopted March, 2023

Each individual member, including Life members need to fill one in yearly!
Dues: $11.00 (includes $1.00 online processing fee)
Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone:*
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Email:*
example@example.com
May we share your information with other club members?*

YesNo
Do you want to receive emails concerning Club Business?

YesNo
Life Members: would you like to remain on our roster and mailing list?

YesNo
- Full Members must have completed the 6 month introductory period. (Voting Priviledges)
- Associate Members may apply for Full Membership after 6 months. (No Voting Priviledges)
- Junior Members may apply for Associate or Full Membership after the age of 18, and other requirements of the level of Membership have been met.
- Life Members have voting priviledges
Club Agreement:*

I agree to abide by the Peninsula Dog Fanciers' Club and AKC Rules, Regulations, Policies and Guidelines.
Signature:*
(Typing your name in this box constitutes a signature)
Date*

MonthDayYear
Date
Choose the type Membership you are renewing:*
prevnext( X )
Full Membership
$11.00 for each year



Associate Member
$11.00 for each year



Junior Membership
$ Free   for each year



Life Membership
$ Free   for each year
For Club Use:
Payment Method:

CashCheckOnline
Copy sent to:

SecretaryTreasurerPresident
Membership Chair Initials
Date
Should be Empty: