PNW CSF Annual Membership Form

PNW Clumber Spaniel Fanciers

Annual Membership Application
Annual membership dues are due on or before May 1, 2025, for the period May 1, 2025 through April 30, 2026. Dues must be paid to be a member in good standing with voting privileges.

All members please complete the following form and sign to renew membership and complete payment following the instructions provided (Zelle and checks are accepted). Payment in US Currency only will be accepted.
MEMBER INFORMATION:

Gathered to support membership status updated annually.
Name*

First NameLast Name
For Household memberships, second member Name:

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail (primary)*
example@example.com
Phone Number (primary)*
E-mail (For household membership, 2nd member email)
example@example.com
Phone Number (For household membership, 2nd member phone)
Kennel Name (if any):
Select Membership Type:
prevnext( X )
Single Membership (US)Subscribe to the purposes of this Club which shall include eligibility to vote and hold office.
$25.00



Household Membership (US)Household - includes two adult members residing in the same residence; Subscribe to the purposes of this Club which shall include eligibility to vote and hold office.
$35.00



Associate Single MembershipSubscribe to the purposes of this Club and shall be entitled to all club privileges except voting and office holding.
$15.00



Associate Household MembershipSubscribe to the purposes of this Club and shall be entitled to all club privileges except voting and office holding.
$20.00



Junior membership (up to 17 years) Open to all persons under 18 years of age as non-voting/non office holding members.
$ Free



Single Membership (Foreign Country)Individuals who are not U.S. residents, entitled to all club privileges except voting and office holding.
$65.00



Household Membership (Foreign Country)Individuals who are not U.S. residents, entitled to all club privileges except voting and office holding. Household - includes two adult members residing in the same residence.
$75.00
AKC CLUB INFORMATION:

Gathered to support club reporting on an annual basis.
Number of clumber spaniels i own:

Enter experience type and years experience:

	Less than 2 years	3 - 5 years	6 - 10 years	11 - 15 years	> 15 years
Dog Owner
Exhibitor
Breeder
Judge

AKC Participation (select all that apply):*

ConformationHuntingScent WorkObedience/ RallyTrackingI do not participate in AKC events
PAYMENT INSTRUCTIONS:
Please make payment through Zelle pay (using email address:

pnwclumbers@gmail.com.

If you prefer to send a check please pay to the order of: PNW Clumbers and mail check to: Charlie Zaragoza, ATTN: PNWCSF Treasurer, 814 NE 96th Street, Seattle, WA 98115.
CODE OF ETHICS:
Link to Code of Ethics for review.

My signaure below represents that I understand and agree to the Code of Ethics, that I understand that my acceptance of this Code of Ethics, and subjects me to the provisions and procedures as stated.
Date of Signature*

MonthDayYear
Date
Signature*

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Privacy Notice
The PNW Clumber Spaniel Fanciers (PNWCSF) respect your privacy. All personal information collected by the club concerning its members will be kept strictly confidential. Your personal information will never be sold and will not be disclosed to unaffiliated third parties without your permission. Your information will be shared via any forms of communication allowed by its Constitution and Bylaws (email communications, Facebook communications).
Interests and Volunteer Opportunities:

Please let us know of your interests.
I am interested in the following club volunteer opportunities (select all that apply)::*

Picnic/ Walk CoordinatorPublic Education EventsAssist with Club Sponsored EventsCoordinate Fundraiser ActivityRun for an elected Board Officer position (elections held in October!)Other
If Other above, please describe the area you are interested to support:
I am interested in participating in the following club events (select all that apply):*

Conformation/ Show Events (Regional Specialty)FastCat EventsScent Work TrialsTracking Events (tracking dog, tracking dog urban)Spaniel Hunt TestObedience/ Rally EventsPublic Education EventsPicnic/Club Fun EventsOther
If Other above, please describe events you have an interest to attend:
Should be Empty:

PNW Clumber Spaniel Fanciers

MEMBER INFORMATION:

AKC CLUB INFORMATION:

PAYMENT INSTRUCTIONS:

CODE OF ETHICS:

Interests and Volunteer Opportunities: