Membership Renewal for Chintimini Kennel Club
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
*
Life Member ($0)
Household ($15)
Individual ($10)
Associate (non-voting; $5)
Junior (under 18; non-voting $5)
Membership Fee
Membership Fee Payment
*
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USD
Membership Dues
Credit Card
Submit
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