Clone of ASHBA NEW Charter Club Application

ASHBA Reinstatement of Charter Club

This form will go to the ASHBA Board of Directors for approval and if the Board does not approve, the payment will be refunded to the original payee.
Name of Club
State or Area Represented
Name of Club Contact

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Approximate Date of Annual Membership Meeting
What would your two charter club events potentially be?
Please explain why the club originally dropped and why you would like to become a club again.
For the Officer List and Membership List please fill in the excel document here

Excel Roster Template
Upload Officer List: Please include name, email, phone

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Upload Membership List: Please Include birth dates, mailing and email addresses.

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Attach Current Club Bylaws: Please attach as Word Document or PDF

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Charter Club Application Fee

$45.00 Quantity

Breed Ambassador Donation

$25.00 Quantity

Subtotal

Tax

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

ASHBA Reinstatement of Charter Club