Hmong Bobtail Club of America

Hmong Bobtail Club of America

Membership Form
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If you are applying as a household please add additional member names, relevant address, and contact information. Please include whether each member is applying as a Breeder, Owner, Exhibitor, or Judge.

Rows	Full Name	Address	Contact Number	Status
1
2
3
4

Additional Information
Briefly describe your experience and involvement with the breed*
Do you own at least one Hmong Bobtail that you want registered with the club or own at least one Hmong Bobtail that is currently registered with the club?*

Yes, I own a HB(s) that is already registered.Yes, I would like to register my HB(s).No, I own a HB mixNo, I don’t own a purebred or mixOther
Please check all 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 Hmongbobtail@gmail.com)*

I have sent the $20 USD individual membership fee to the HBCAI have sent the $50 USD household/family membership fee to the HBCA
Are you over the age of 18?*

YesNo, I would like to apply for a junior membership
I understand that this application will hereby apply me for membership with the HBCA upon submission and that I agree to the club’s Constitution, Bylaws, and Code of Ethics.*

I agree
Date*

MonthDayYear
Date
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 hmongbobtail@gmail.com instead.
Signature*
Should be Empty: