IWC Membership Application

International Windsprite Club (IWC) Membership Application

September 28-29, 2019
Please fill out form completely, and double check before clicking the "SUBMIT" button at the very end.

All fields with an * are required.
APPLICANT INFORMATION
Date

Month Day Year
mm-dd-yyyy or use calendar button
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State/Province

Zip/Postal Code Country
Home Phone Number

Area Code Phone Number
Mobile Phone Number

Area Code Phone Number
Email *
example@example.com
Membership Type *

Individual Family Junior (age 10-17)
Age if Junior
Additional Names for Family Membership:
Name, Age, Email
Name, Age, Email
Name, Age, Email
Endorser's Name
Endorser's Email
Agreement:

With my signature I certify that the above information is true and complete, and I agree to comply with the Code of Ethics, to support the Bylaws, and to strive to fulfill the Mission and Vision of the International Windsprite Club.
E-Signature (Parent/Guardian if < 18 years of age) *
Typed signature constitutes a valid electronic signature
APPLICANT PROFILE:
Occupation:
Do you currently own a Windsprite or have you in the past? (Membership is not dependent upon owning a Windsprite)

I currently own a Windsprite I have prevoiusly owned a Windsprite I have not owned a Windsprite
Number of Years in Windsprites?
Number of Windsprites currently owned?
Have you ever bred a litter of Windsprites?
Other breeds you have owned or bred?
Areas of Interest (check all that apply)

Conformation Breeding Agility Lure Coursing/Racing Obedience/Rally Dock Diving Nosework/Barn Hunt Flyball
Do you have active membership in any other dog clubs? If yes, please list the name of the club(s) and offices held, if any.
Are you an approved judge for any canine activity? If so, list which activity and organization. (ie agility/CPE)
Please list any areas of Club related activity in which you might like to become involved.
Additional questions or comments?
Payment: *

Payment via PayPal: click on desired PayPal Button. (If you wish to pay with a credit card without using a personal PayPal account, click on one of the little credit cards in the bottom row.) Mail check or money order (Please make payable to "IWC" and mail to: IWC c/o Sidney Hoblit, 33 Pine Grove Rd, Nottingham PA 19362)
TOTAL PAYPAL PAYMENT
prev next ( X )
Individual Membership - 1 year $ 20.00

Individual Membership if applying after July 1 $ 10.00

Junior Membership 1 year $ 10.00

Junior Membership if applyling after July 1 $ 5.00

Family Membership 1 year $30 $ 30.00

Family Membership if applying after July 1 $ 15.00

Total $ 0.00
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If you have any questions or problems with filling out the form, contact Sidney Hoblit LHWLady@gmail.com
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International Windsprite Club (IWC) Membership Application