WMU Membership Application

WMU Membership Application
ADMIN USE: WMU Card Sent?
ADMIN USE: Member Number
ADMIN USE: Membership Type
I am a

New Member.Renewing Member and my information is the same.Renewing Member and would like to update my information.
Name*

First NameLast Name
ADMIN USE: Membership Expires
ADMIN USE: Membership Renewed
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Events I plan to participate in:

FKA Schutzhund (IPO, IGP etc.)Mondio RingFrench RingPSAObedienceRallyAgilitySearch and RescueNoseworkTrackingOther
Breeds I own:

Cane CorsoOther
2nd Family Member's Name*

First NameLast Name
2nd Family Member's email*
example@example.com
Please allow 2-4 weeks for processing of membership cards. If you do not receive your card after 4 weeks please contact us at: workingmolossers@gmail.com
My Products
prevnext( X )
Regular Membership$30.00

Family Membership$40.00

Total $0.00
ADMIN USE: Board/Committee Position
ADMIN USE: Notes
Pay with PayPal

Choose from one of the PayPal options to make your payment.
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