Membership Renewal for Chintimini Kennel Club
Life Members use form: https://form.jotform.com/ChintiminiKC/life-membership-renewal
Member
*
First Name
Last Name
co-Member
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
My (Our) Address has changed since the last membership renewal.
*
Yes
No
Phone Number
*
-
Area Code
Phone Number
Member Mobil Phone Number
*
-
Area Code
Phone Number
co-Member Mobil Phone Number
-
Area Code
Phone Number
My (Our) Phone Numbers have changed since the last membership renewal.
*
Yes
No
Member Email
*
Confirmation Email
example@example.com
co-Member Email
Confirmation Email
example@example.com
My (Our) Emails have changed since the last membership renewal.
*
Yes
No
I (We) consent to having meeting notices and other club notices sent to the email addresses provide in this renewal application
*
Yes
No
Type of Membership
*
Household ($15)
Individual ($10)
Associate (non-voting; $5)
Junior (under 18; non-voting $5)
Membership Cards Type
*
Electronic image of your card emailed?
Paper card mailed?
Both
Membership Fee
Membership Fee Payment
*
prev
next
( X )
USD
Membership Dues
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Submit
Should be Empty: