IHCUS Renewal Form

IHCUS Renewal Form
Renewal Type (Select Applicable Renewal Type(s))*

MembershipBreeder Referral
Membership Type
Number of Additional Family Members
Member Name As Currently Shown on Membership List*

First NameLast Name
Member Email as Currently Shown on Membership List*
example@example.com
Additional Member Names as Currently Shown on Membership List
Additional Member Emails as Currently Shown on Membership list (If different from above)
example@example.com
Does any information need updated? *
(Eg. Name, Address, Phone, Email, Kennel Name, Year Joined IHCUS)
Select Information to be updated

NameAddressPhoneEmailKennel NameYear Joined IHCUS
New Name

First NameLast Name
New Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
New Email
example@example.com
New Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
New Kennel Name
Year Joined IHCUS
Information Update Notes
Donation
I would like to make a donation to IHCUS*

YesNo
Donation Amount
I would like my donation to go towards the following (select all that apply)

General ExpensesRescueTrophyWays and MeansOther
Payment Method*

CheckPayPal
Total Amount Due
Total Due
Override Total Due
Amount Due: Check
See Amount Due: Check Field

After form submission, Make check for amount owed (payable in US Funds) to IHCUS and Mail to:

Pam Fusco (IHCUS Treasurer)
3451 S Grosvenor Hwy
Palmyra MI 49268

Renewals will not be process until after payment receipt.
Amount Due: PayPal
Amount Due: PayPal Calculation Field
Payment Method: PayPal

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USDYearly Renewals
I understand that by signing this membership renewal document:*

I am subject to IHCUS’s bylaws and constitution.I consent to IHCUS sharing my membership information, as necessary, with the American Kennel Club (AKC) and other third parties for purposes related to club business.I agree to participate in and be bound by decisions made through electronic voting methods as adopted by IHCUS.
Signature*
Date

MonthDayYear
Date
Should be Empty:

IHCUS Renewal Form

Donation

Total Amount Due